Awareness and sensitization seminar By Faculty of Medicine Kaduna State University - PowerPoint PPT Presentation


Title: Awareness and sensitization seminar By Faculty of Medicine Kaduna State University


1
Awareness and sensitization seminar ByFaculty
of MedicineKaduna State University
  • MYTHS AND REALITIES OF
  • EBOLA VIRUS DISEASE (Updated on Oct 19, 2014)

2
Presentation outline
  • Introduction Professor Elegba (Medical
    Microbiology)
  • Epidemiology Dr. MA Kana (Community Medicine)
  • Treatment Dr. H Bello-Manga (Haematology)
  • Prevention Dr. F Adiri (Community Medicine)
  • Conclusion Professor OY Elegba

Authors of the lecture on Myths and Realities of
EVD
3
Introduction
  • Professor OY Elegba
  • Department of Medical Microbiology

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6
Introduction
  • Ebola Virus Disease is a severe, highly
    infectious and often rapidly fatal illness that
    first appeared in 1976 almost simultaneously in
    Nzara, Sudan and Yambuku in the Democratic
    republic of Congo.
  • They were of two different strains, the Sudan
    strain and the Zaire strain.
  • The natural reservoir was never identified.
  • The third strain was discovered during necropsy
    in 1994 in Cote DIvoire , a fourth, from Uganda
    called the Bundibugyo strain in 2008 and a fifth
    strain, the Reston strain was discovered
    accidentally in a military laboratory, Virginia
    USA also in 2008 from samples brought from the
    Phillipines.

7
Introduction
  • EVD is caused by Ebola Virus belonging to a group
    of viruses responsible for Viral hemorrhagic
    fevers like Lassa fever, Yellow fever, Marburg
    and Dengue fever.
  • They are called hemorrhagic because of the
    distinct scary bleeding that occur during the
    course of the illness.
  • The word hemorrhagic is now left out in the case
    of Ebola because the illness is not always
    accompanied by bleeding.

8
Introduction
  • The virus is a complex level four pathogen.
  • It is an enveloped RNA virus belonging to the
    family Filoviridae, genus Ebolaviridae and order
    Mononegavirales.
  • Four of the five strains are known to have caused
    disease in man.
  • These are Zaire Ebola virus (EBOV previously
    ZEBOV), Sudan Ebola virus (SUDV previously
    SEBOV), Tai forest Ebola virus formerly known as
    Cote DIvoire Ebola virus (TAFV previously
    CIEBOV), and Bundibugyo Ebola virus (BDBV
    previously BEBOV.

9
Introduction
  • The Reston strain has not been linked with any
    infections in humans and is largely found in East
    Asia.
  • The filoviridae has two other members which are
    Marburg and Cuevavirus with Marburg said to be
    almost as vicious as Ebola.
  • The different strains of Ebola have different
    mortality rates ranging between 50-90.
  • The deadliest of the strain is the Zaire strain
    which is responsible for the present outbreak.

10
Introduction
  • There have been several outbreaks in central and
    eastern Africa but
  • these outbreaks were all contained within few
    months.
  • The total number of cases from all the previous
    outbreaks were 2,387 and 1,590 deaths according
    to World Health Organization in comparison with
    the the present outbreak where over 4,000 cases
    and over 2,000 deaths have been recorded.
  • Presently, about six African countries have been
    affected including Nigeria, Liberia, Senegal,
    Cote DIvoire, Guinea and the Democratic Republic
    of Congo.

11
Introduction
  • The virus is transmitted from infected animals
    that live in the rain forest through contact with
    blood and other body secretions.
  • It then spreads amongst humans in
    discriminatively.
  • Health workers and family members of the sick
    being most at risk.
  • It cannot be spread by airborne routes but can
    be spread by droplets.
  • Current outbreak is characterized by eruption of
    symptoms 4-6 days after exposure.
  • The outbreak has almost crushed the countries
    affected both economically and health wise
    especially in the way it decimates their health
    workers.
  • It is also known that there is seropositivity in
    most regions of Africa even in areas where no
    cases have been reported yet.

12
Introduction
  • The origin of this virus is not known, but fruit
    bats (Pteropodidae) are considered the most
    likely hosts based on available evidence e.g the
    absence of clinical signs in them is
    characteristic of a reservoir specie.
  • High lethality in monkeys, chimpanzees, and
    gorillas make them unlikely natural reservoirs
  • Evidence has implicated that wild pigs and
    porcupine may also be natural hosts to the virus

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Introduction
  • This virus cause havoc by first evading the
    dendritic cells and macrophages thereby confusing
    the immune system of the body.
  • With its continued replication, the more
    powerful antibodies and cytokines are produced
    massively resulting in what is referred to as
    cytokine storm characterized by the symptoms
    and signs of the disease.
  • This host response to the virus eventually affect
    all organs, bursting blood vessels and causing
    bleeding both internally and externally and also
    causing severe dehydration from the vomiting and
    diarrhea resulting in low blood pressure and
    death.

16
Introduction
  • The current outbreak crossed porous borders and
    has been going on for months.
  • It has defied all predictions and it is
    impossible to predict how it will end.
  • Prof Langwick of Cornell University said, Part
    of what were seeing is our intense
    inter-connectedness in todays world. People
    travel. People need to travel to make their
    livelihoods, to get food, to see relatives, to
    care for each other, for their jobs and their
    profession. And I think were seeing a very
    effective and devastating virus take advantage of
    the fact that we are a very inter-connected
    world.

17
Introduction
  • There are no proven drugs or vaccines to treat or
    prevent Ebola even though researches are going
    on along these lines.
  • The rarity of the disease and its prevalence in
    largely poor African nations has not provided
    enough incentive for big pharmaceutical companies
    to tackle this virus.
  • Only small biotechnological, pharmaceutical
    firms, and Government funded laboratories have
    been attracted to this forage and taken up the
    challenge
  • These companies and groups are often poorly
    funded and do not have the where with all to
    tackle such gigantic research programs and often
    may not record huge successes.

18
Introduction
  • The quick and horrible death of Ebola victims and
    the potential threat of epidemics was captured in
    the 1994 best selling non-fiction thriller The
    Hot Zone and Outbreak, the epidemic is no
    longer just a threat, it is real
  • It is how we will conquer it that is important,
    and conquer it we must.
  • This virus has been considered a possible
    vehicle for bioterrorism.
  • The US CDC and Prevention lists the virus as a
    category A Bioterrorism agent alongside Anthrax
    and Smallpox.
  • All these must be addressed fully so that we will
    not be caught unprepared.

19
Epidemiology of EVDDr. MA KanaDepartment of
Community Medicine
20
Myths
  • There are claims that the following measures have
    prophylactic or curative effect
  • Chewing bitter cola (Gracinia cola or G. Afzelii)
  • Eating ewedu cochorus olitorius (a vegetable
    commonly eaten as soup in Nigeria)
  • Salt bath and drink
  • Kerosene bath
  • Bath with bleaching agent (sodium hypochlorite)
  • Social media has been used to transmit
    information about these myths
  • Consequently, many have died in Nigeria as a
    result of the ingestion of over concentrated salt
    drink
  • Research and health education is required to
    verify and highlight the danger of these claims

21
Where is Ebola virus found in nature?
  • Because the natural reservoir of ebola viruses
    has not yet been proven
  • The manner in which the virus first appears in a
    human at the start of an outbreak is unknown
  • However, researchers have hypothesized that the
    first patient becomes infected through contact
    with an infected animal

22
Ebola Landscape
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Where do cases of Ebola virus disease occur?
  • In the past Confirmed cases of Ebola HF have been
    reported in the Democratic Republic of the Congo,
    Gabon, Sudan, the Ivory Coast, Uganda, and the
    Republic of the Congo
  • Ebola HF typically appears in sporadic outbreaks,
    usually spread within a health-care setting (a
    situation known as amplification)
  • It is likely that sporadic, isolated cases occur
    as well, but go unrecognized

26
  • When an infection does occur in humans, the virus
    can be spread in several ways to others
  • The virus is spread through direct contact
    (through broken skin or mucous membranes) with
  • a sick person's blood or body fluids (urine,
    saliva, feces, vomit, breast milk and semen)
  • objects (such as needles) that have been
    contaminated with infected body fluids home
    cooking utensils, towels, bed linen
  • infected animals
  • Handling of corpse and burial rites
  • Other modes of transmission are being
    investigated

27
  • Healthcare workers and the family and friends in
    close contact with Ebola patients are at the
    highest risk of getting sick because they may
    come in contact with infected blood or body
    fluids
  • During outbreaks of EVD, the disease can spread
    quickly within healthcare settings (such as a
    clinic or hospital)
  • Exposure to ebola viruses can occur in healthcare
    settings where hospital staff are not wearing
    appropriate protective equipment, such as masks,
    gowns, and gloves

28
Transmission and Infectivity
29
Distribution
30
Ebola outbreaks, 1976-2014
31
  • The 2014 Ebola outbreak is the largest Ebola
    outbreak in history and the first in West Africa
  • The current outbreak is affecting multiple
    countries in West Africa with Guinea, Liberia and
    Sierra Leone most affected
  • To date, four countries, Nigeria, Senegal, Spain,
    and the United States of America have reported a
    case or cases imported from a country with
    widespread and intense transmission
  • In Nigeria, there have been 20 cases and eight
    deaths, while in Senegal, there has been one case
  • Nigeria and Senegal have contained its spread

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Burden
Case Counts 20th October 2014
34
Countries With Widespread And Intense Transmission
Country Case definition Cases Deaths
Guinea Confirmed 1217 671
Guinea Probable 191 191
Guinea Suspected 111 0
Guinea All 1519 862
Liberia Confirmed
Liberia Probable
Liberia Suspected
Liberia All 4262 2484
Sierra Leone Confirmed 2977 932
Sierra Leone Probable 37 161
Sierra Leone Suspected 396 107
Sierra Leone All 3410 1200
Sierra Leone Confirmed 2977 932
Total   9191 4546
35
Countries with Travel-associated Cases
Country Total cases Laboratory confirmed cases Total deaths
Senegal 1 1 0
Spain 1 1 0
USA 3 3 1
Total 5 5 1

36
Countries with Localized Transmission
Country Total cases Laboratory confirmed cases Total deaths
Nigeria 20 19 8
37
Ebola Outbreak in The Congo DRC
  • As at 9 October 2014, and following a
    retrospective laboratory review of cases, there
    have been 68 cases (38 confirmed, 28 probable, 2
    suspected) of Ebola virus disease (EVD) reported
    in the Democratic Republic of the Congo,
    including eight among healthcare workers (HCWs)
  • In total, 49 deaths have been reported, including
    eight among HCWs. 852 contacts have now completed
    21-day follow-up
  • Of 269 contacts currently being monitored, all
    (100) were seen on 9 October, the last date for
    which data has been reported.
  • The last confirmed case was isolated on 4 October
  • This outbreak is unrelated to that affecting
    Guinea, Liberia, Nigeria, Sierra Leone, Spain,
    and the United States of America.

38
Situation report 20th October 2014
  • In Nigeria, all 891 contacts have now completed
    21-day follow-up (362 contacts in Lagos, 529
    contacts in Port Harcourt).
  • A second EVD-negative sample was obtained from
    the last confirmed case on 8 September (39 days
    ago)
  • In Senegal, a second EVD-negative sample was
    obtained from the single confirmed case on 5
    September (42 days ago)
  • WHO officially declares the Ebola outbreak in
    Senegal over on 17th October 2014
  • In Spain, 72 people, including 13 high-risk
    contacts, are being monitored.
  • In the United States of America, 125 contacts are
    being monitored.

39
Consequences of EVD
  • Global pandemic - The combination of modern
    health systems and the limited communicability of
    the virus make it unlikely to spread in developed
    countries.
  • Political right and freedom On Aug. 6, Liberian
    President Ellen Johnson Sirleaf declared a
    national emergency and suspended constitutional
    rights for a 90-day period, citing unrest that
    represents a clear and present danger to the
    country.
  • Social - The virus has torn an already fragile
    society in affected countries damaged from years
    of civil war
  • Health system overwhelmed resources and
    infrastructure, loss of valuable human resource
  • Economy loss of revenue (tourism, trade,
    agriculture)
  • Future of the impact medical waste scavenging
    and wildlife migration, bioterrorism, national
    debt, political, economic and social instability,
    threat to national security

40
Management of Ebola Virus Disease(EVD)
  • Dr. Halima Bello-Manga
  • Department of Haematology

41
Management of EVD
  • The management of EVD is hinged on the following
    principles
  • Proper history and Physical Examination
  • Lab investigation(diagnosis).
  • Supportive therapy

42
Medical History
  • EVD in its initial phase mimicks many other
    febrile illnesses e.g. malaria, common cold,
    typhoid fever, thus a high index of suspicion has
    to be shown.
  • A history of exposure to the disease in the last
    2-21 days prior to the onset of symptoms should
    be established.
  • Exposure could be in the form of
  • Contact with a person diagnosed with the disease
    e.g. caring for, visiting or even a attending the
    burial of an infected person. (Patients at risk
    include health care workers, family and friends,
    traditional healers, morticians, etc)
  • Hx of contact with contaminated materials used
    by a patient diagnosed with the disease, e.g. bed
    linen, eating utensils, medical equipment, etc.

43
Medical History Contd
  • Contact with infected animals e.g
    apes/chimpanzees, fruit bats, pigs ( especially
    during processing) or eating.
  • History of travel to endemic areas or contact
    with someone with a hx of travel to such areas.

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Diagnosis
  • Once a case of EVD is suspected, the person is
    isolated and samples are sent for diagnosis.
    Samples are considered highly infectious and
    should be treated as such.
  • Diagnostic investigations include
  • ELISA ( Ag capture, IgM Antibody)
  • RT-PCR (confirmatory)
  • IgM and IgG detection
  • Virus isolation ( cell culture)
  • Electron microscopy
  • Immunohistochemistry( esp at post mortem).

46
Treatment
  • There is no specific treatment medicine/drug or
    vaccine for EVD. (those available are in the
    trial phase) thus, the hallmark for the Rx of the
    Dx remains SUPPORTIVE, which include
  • Provision of IV fluids and correcting electrolyte
    imbalances.
  • Maintaining Oxygen saturation and blood pressure.
  • Treating other secondary infections with
    antimicrobials.
  • Good nutrition.
  • Use of anticoagulants in cases of DIC.

47
Treatment Contd
  • Blood transfusion ( blood from patients that have
    recovered from EVD) seems to help and the WHO has
    approved its use in the treatment of patients.
  • In addition to the above, in actively bleeding
    patients with DIC, blood transfusion is used in
    replacing clotting factors, red cells and
    platelets( esp if component transfusion is done).
  • Psychological support is a very important aspect
    in the mx of ebola as the dx is associated with a
    lot of fear and anxiety because of its high
    mortality rate.

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Prognosis
  • EVD has a very high fatality rate of up to 90
    (when little or no medical intervention is
    instituted), with supportive care, it reduces to
    about 50 or lower with early appropriate
    intervention

50
Glimpses of Hope
  • The current outbreak has caused a heightened
    international response towards this emerging
    disease and the world (mostly 1st world) has
    swung into action towards getting a cure for the
    disease.
  • The experimental drug ZMapp seems to be effective
    in the treatment. ( not available for use now).
  • At least 10 drugs and 2 vaccines against Ebola
    Virus dx are currently under development (WHO).

51
Prevention and Control
  • Dr. Faruk Adiri
  • Department of Community Medicine

52
Community Prevention and Control
  • Wash your hands regularly and properly use
    soap, disinfectant hand sanitizers
  • Avoid physical contacts (hand shake, hugging,
    kissing)
  • DO NOT touch, wash or kiss an infected person/
    dead body
  • Avoid their body fluids, including blood, vomit,
    faeces, urine
  • DO NOT touch or eat bush meat and dont eat
    bats
  • Cook animal product thoroughly

53
Community prevention and Control
  • Call your medical centre early and tell them
    about your illness
  • Listen to the advice/key messages.
  • You may be sent to a special hospital
  • Keep away from others so they dont get sick
  • Be especially careful of your vomit and diarrhoea
  • Safe burial practices
  • Practice general sanitation/hygiene

54
Prevention and Control-Animals
  • During outbreaks quarantine premises/farms
    affected
  • PPE while handling animals
  • Cull infected animals
  • Incineration of carcasses
  • Supervise burials closely
  • Ban movements and sale of infected animals from
    affected areas
  • Active animal health surveillance

55
Prevention and Control-Humans
  • Raise awareness with key messages
  • Avoid close contact (within 1 meter)
  • Proper hand washing
  • PPE while handling patients
  • Standard precaution/procedure for infection
    control
  • Safe burial practice (incineration)

56
Principles of Prevention
  • Contact tracing
  • Active case management
  • Surveillance

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Conclusion
  • Ebola, supposedly does not travel through the
    air, making it harder to transmit than other
    pathogens that cause epidemics such as the
    Influenza virus.
  • It has been established that with good health
    care practices, the disease can be contained and
    may not be as vicious a killer as other
    infections that have bedeviled us in the past.
  • The Flu virus kills up to ½ a million every year
    and even as high as 50 million during the great
    pandemic of 1917-1918, not to mention emerging
    infectious diseases like resistant tuberculosis,
    and even severe antibiotic resistance that has
    now become a huge public health issue.
  • So it is extremely important that we do not panic
    as fear can drive sick people underground making
    contact tracing impossible and aiding the spread
    to unaffected areas.

61
Conclusion
  • The present outbreak started in Guinea and
    quickly spread to two other West African
    countries which are about the poorest on earth.
  • These countries are all inundated with poor
    health care, resulting in challenges that are
    probably too heavy for them to bear.
  • These, accompanied with the biases and prejudices
    of the local populations, have made responses
    inadequate resulting into what we have today.
  • It may be necessary to involve All concerned,
    like, community leaders, religious gurus and
    even traditional healers for effective
    intervention as long as they are aware of the
    risks of Ebola as good healers are skillful in
    conceiving and promoting therapies that intervene
    in the dynamics of biological diseases and human
    relationships

62
Conclusion
  • Prof Langwick of Cornell University said that
    when people live in an area with poor health
    facilities surrounded by death and fear of death,
    it is an infuriating and terrifying situation
    which can result in desperation.
  • This desperation can result in distrust and
    violence as happened recently in Liberia.
  • How we care for our people especially in the face
    of danger is very important and Prof Langwick
    described it very appropriately as the ethics of
    living, the ethics of caring.
  • This is the time to act and be prepared.

63
Conclusion
  • As yet, we are lucky that Ebola is not in this
    part of the country. So what is important now is
    for us to prevent it from getting here and
    prepare for how we will control it if and when it
    eventually gets here.
  • We can play our parts by educating ALL around us,
    in our homes, classes, religious settings etc
    etc.
  • Correct politely, bad habits like spitting,
    sneezing without covering the mouth and blowing
    of the nose publicly, and teach people about
    basic infection control themes like washing hands
    properly.
  • Emphasis must be placed on how this disease is
    transmitted especially amongst sick family
    members and about safe burial practices.

64
Conclusion
  • We must not let what happened in Liberia Guinea
    and Sierra Leone be repeated here.
  • Plan, Plan Plan. Identify health workers
    including epidemiologists that will be capable of
    dealing with the situation
  • PPE and other essentials must be provided
    adequately. So also we must have ambulances, and
    even train specially those who will undertake
    burials.
  • Link with local Government council chairmen so as
    to avoid shadow zones
  • Data collection is extremely important and
    epidemiological surveillance must be instituted.

65
Conclusion
  • Interestingly, caregivers at the front line bear
    the brunt of this dreadful disease- a sobering
    fact being the demise of the five co-authors of
    an Ebola genome analysis study who died before
    even the publication of their work.
  • The research project published in the JOURNAL OF
    SCIENCE sequenced the Ebola genome thus paving
    way for plotting mutation and thereby finding the
    origin of the virus.
  • The research has provided data about how the
    virus operates and hopefully will help in the
    development of effective drugs and vaccines.
  • We must salute these fellows, MBALU FONNIE, ALEX
    MOGBOI, ALICE KOROMA, MOHAMMED FULLAH AND SHEIK
    HUMARR KHAN who died in the process of finding
    solution to the problem of Ebola.
  • Coming nearer home, we must salute our health
    care workers like Dr Stella Adadevoh and others
    who lost their lives in the process of treating
    the Index case Patrick Sawyer..

66
Conclusion
  • In a video which appeared in the White House
    website and was aimed at West African countries
    struggling with the outbreak, President Obama
    said Stopping this disease wont be easy. But we
    know how to do it. You are not alone, together we
    can treat those who are sick with respect and
    dignity. We can save lives and our countries can
    work together to improve Public Health so this
    kind of outbreak doesnt happen again
  • AND FINALLY

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  • LET US ALL PREVENT EBOLA

68
Acknowledgement
  • The organizations and authors of reports and
    information we cited for the development of this
    presentation
  • World Health Organization Global Alert and
    Response (GAR) Situation Reports
  • World Health Organization Disease Outbreak News
    (DON)
  • World Health Organizations Epidemic and Pandemic
    Alert and Response (EPR)
  • Guinea Ebola epidemic declared, MSF launches
    emergency response
  • http//www.cdc.gov/vhf/ebola/outbreaks/2014-west-a
    frica/case-counts.html
  • http//apps.who.int/iris/bitstream/10665/136645/1/
    roadmapupdate17Oct14_eng.pdf?ua1
  • http//www.who.int/csr/disease/ebola/en/
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Title: Awareness and sensitization seminar By Faculty of Medicine Kaduna State University


1
Awareness and sensitization seminar ByFaculty
of MedicineKaduna State University
  • MYTHS AND REALITIES OF
  • EBOLA VIRUS DISEASE (Updated on Oct 19, 2014)

2
Presentation outline
  • Introduction Professor Elegba (Medical
    Microbiology)
  • Epidemiology Dr. MA Kana (Community Medicine)
  • Treatment Dr. H Bello-Manga (Haematology)
  • Prevention Dr. F Adiri (Community Medicine)
  • Conclusion Professor OY Elegba

Authors of the lecture on Myths and Realities of
EVD
3
Introduction
  • Professor OY Elegba
  • Department of Medical Microbiology

4
(No Transcript)
5
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6
Introduction
  • Ebola Virus Disease is a severe, highly
    infectious and often rapidly fatal illness that
    first appeared in 1976 almost simultaneously in
    Nzara, Sudan and Yambuku in the Democratic
    republic of Congo.
  • They were of two different strains, the Sudan
    strain and the Zaire strain.
  • The natural reservoir was never identified.
  • The third strain was discovered during necropsy
    in 1994 in Cote DIvoire , a fourth, from Uganda
    called the Bundibugyo strain in 2008 and a fifth
    strain, the Reston strain was discovered
    accidentally in a military laboratory, Virginia
    USA also in 2008 from samples brought from the
    Phillipines.

7
Introduction
  • EVD is caused by Ebola Virus belonging to a group
    of viruses responsible for Viral hemorrhagic
    fevers like Lassa fever, Yellow fever, Marburg
    and Dengue fever.
  • They are called hemorrhagic because of the
    distinct scary bleeding that occur during the
    course of the illness.
  • The word hemorrhagic is now left out in the case
    of Ebola because the illness is not always
    accompanied by bleeding.

8
Introduction
  • The virus is a complex level four pathogen.
  • It is an enveloped RNA virus belonging to the
    family Filoviridae, genus Ebolaviridae and order
    Mononegavirales.
  • Four of the five strains are known to have caused
    disease in man.
  • These are Zaire Ebola virus (EBOV previously
    ZEBOV), Sudan Ebola virus (SUDV previously
    SEBOV), Tai forest Ebola virus formerly known as
    Cote DIvoire Ebola virus (TAFV previously
    CIEBOV), and Bundibugyo Ebola virus (BDBV
    previously BEBOV.

9
Introduction
  • The Reston strain has not been linked with any
    infections in humans and is largely found in East
    Asia.
  • The filoviridae has two other members which are
    Marburg and Cuevavirus with Marburg said to be
    almost as vicious as Ebola.
  • The different strains of Ebola have different
    mortality rates ranging between 50-90.
  • The deadliest of the strain is the Zaire strain
    which is responsible for the present outbreak.

10
Introduction
  • There have been several outbreaks in central and
    eastern Africa but
  • these outbreaks were all contained within few
    months.
  • The total number of cases from all the previous
    outbreaks were 2,387 and 1,590 deaths according
    to World Health Organization in comparison with
    the the present outbreak where over 4,000 cases
    and over 2,000 deaths have been recorded.
  • Presently, about six African countries have been
    affected including Nigeria, Liberia, Senegal,
    Cote DIvoire, Guinea and the Democratic Republic
    of Congo.

11
Introduction
  • The virus is transmitted from infected animals
    that live in the rain forest through contact with
    blood and other body secretions.
  • It then spreads amongst humans in
    discriminatively.
  • Health workers and family members of the sick
    being most at risk.
  • It cannot be spread by airborne routes but can
    be spread by droplets.
  • Current outbreak is characterized by eruption of
    symptoms 4-6 days after exposure.
  • The outbreak has almost crushed the countries
    affected both economically and health wise
    especially in the way it decimates their health
    workers.
  • It is also known that there is seropositivity in
    most regions of Africa even in areas where no
    cases have been reported yet.

12
Introduction
  • The origin of this virus is not known, but fruit
    bats (Pteropodidae) are considered the most
    likely hosts based on available evidence e.g the
    absence of clinical signs in them is
    characteristic of a reservoir specie.
  • High lethality in monkeys, chimpanzees, and
    gorillas make them unlikely natural reservoirs
  • Evidence has implicated that wild pigs and
    porcupine may also be natural hosts to the virus

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Introduction
  • This virus cause havoc by first evading the
    dendritic cells and macrophages thereby confusing
    the immune system of the body.
  • With its continued replication, the more
    powerful antibodies and cytokines are produced
    massively resulting in what is referred to as
    cytokine storm characterized by the symptoms
    and signs of the disease.
  • This host response to the virus eventually affect
    all organs, bursting blood vessels and causing
    bleeding both internally and externally and also
    causing severe dehydration from the vomiting and
    diarrhea resulting in low blood pressure and
    death.

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Introduction
  • The current outbreak crossed porous borders and
    has been going on for months.
  • It has defied all predictions and it is
    impossible to predict how it will end.
  • Prof Langwick of Cornell University said, Part
    of what were seeing is our intense
    inter-connectedness in todays world. People
    travel. People need to travel to make their
    livelihoods, to get food, to see relatives, to
    care for each other, for their jobs and their
    profession. And I think were seeing a very
    effective and devastating virus take advantage of
    the fact that we are a very inter-connected
    world.

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Introduction
  • There are no proven drugs or vaccines to treat or
    prevent Ebola even though researches are going
    on along these lines.
  • The rarity of the disease and its prevalence in
    largely poor African nations has not provided
    enough incentive for big pharmaceutical companies
    to tackle this virus.
  • Only small biotechnological, pharmaceutical
    firms, and Government funded laboratories have
    been attracted to this forage and taken up the
    challenge
  • These companies and groups are often poorly
    funded and do not have the where with all to
    tackle such gigantic research programs and often
    may not record huge successes.

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Introduction
  • The quick and horrible death of Ebola victims and
    the potential threat of epidemics was captured in
    the 1994 best selling non-fiction thriller The
    Hot Zone and Outbreak, the epidemic is no
    longer just a threat, it is real
  • It is how we will conquer it that is important,
    and conquer it we must.
  • This virus has been considered a possible
    vehicle for bioterrorism.
  • The US CDC and Prevention lists the virus as a
    category A Bioterrorism agent alongside Anthrax
    and Smallpox.
  • All these must be addressed fully so that we will
    not be caught unprepared.

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Epidemiology of EVDDr. MA KanaDepartment of
Community Medicine
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Myths
  • There are claims that the following measures have
    prophylactic or curative effect
  • Chewing bitter cola (Gracinia cola or G. Afzelii)
  • Eating ewedu cochorus olitorius (a vegetable
    commonly eaten as soup in Nigeria)
  • Salt bath and drink
  • Kerosene bath
  • Bath with bleaching agent (sodium hypochlorite)
  • Social media has been used to transmit
    information about these myths
  • Consequently, many have died in Nigeria as a
    result of the ingestion of over concentrated salt
    drink
  • Research and health education is required to
    verify and highlight the danger of these claims

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Where is Ebola virus found in nature?
  • Because the natural reservoir of ebola viruses
    has not yet been proven
  • The manner in which the virus first appears in a
    human at the start of an outbreak is unknown
  • However, researchers have hypothesized that the
    first patient becomes infected through contact
    with an infected animal

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Ebola Landscape
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Where do cases of Ebola virus disease occur?
  • In the past Confirmed cases of Ebola HF have been
    reported in the Democratic Republic of the Congo,
    Gabon, Sudan, the Ivory Coast, Uganda, and the
    Republic of the Congo
  • Ebola HF typically appears in sporadic outbreaks,
    usually spread within a health-care setting (a
    situation known as amplification)
  • It is likely that sporadic, isolated cases occur
    as well, but go unrecognized

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  • When an infection does occur in humans, the virus
    can be spread in several ways to others
  • The virus is spread through direct contact
    (through broken skin or mucous membranes) with
  • a sick person's blood or body fluids (urine,
    saliva, feces, vomit, breast milk and semen)
  • objects (such as needles) that have been
    contaminated with infected body fluids home
    cooking utensils, towels, bed linen
  • infected animals
  • Handling of corpse and burial rites
  • Other modes of transmission are being
    investigated

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  • Healthcare workers and the family and friends in
    close contact with Ebola patients are at the
    highest risk of getting sick because they may
    come in contact with infected blood or body
    fluids
  • During outbreaks of EVD, the disease can spread
    quickly within healthcare settings (such as a
    clinic or hospital)
  • Exposure to ebola viruses can occur in healthcare
    settings where hospital staff are not wearing
    appropriate protective equipment, such as masks,
    gowns, and gloves

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Transmission and Infectivity
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Distribution
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Ebola outbreaks, 1976-2014
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  • The 2014 Ebola outbreak is the largest Ebola
    outbreak in history and the first in West Africa
  • The current outbreak is affecting multiple
    countries in West Africa with Guinea, Liberia and
    Sierra Leone most affected
  • To date, four countries, Nigeria, Senegal, Spain,
    and the United States of America have reported a
    case or cases imported from a country with
    widespread and intense transmission
  • In Nigeria, there have been 20 cases and eight
    deaths, while in Senegal, there has been one case
  • Nigeria and Senegal have contained its spread

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Burden
Case Counts 20th October 2014
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Countries With Widespread And Intense Transmission
Country Case definition Cases Deaths
Guinea Confirmed 1217 671
Guinea Probable 191 191
Guinea Suspected 111 0
Guinea All 1519 862
Liberia Confirmed
Liberia Probable
Liberia Suspected
Liberia All 4262 2484
Sierra Leone Confirmed 2977 932
Sierra Leone Probable 37 161
Sierra Leone Suspected 396 107
Sierra Leone All 3410 1200
Sierra Leone Confirmed 2977 932
Total   9191 4546
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Countries with Travel-associated Cases
Country Total cases Laboratory confirmed cases Total deaths
Senegal 1 1 0
Spain 1 1 0
USA 3 3 1
Total 5 5 1

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Countries with Localized Transmission
Country Total cases Laboratory confirmed cases Total deaths
Nigeria 20 19 8
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Ebola Outbreak in The Congo DRC
  • As at 9 October 2014, and following a
    retrospective laboratory review of cases, there
    have been 68 cases (38 confirmed, 28 probable, 2
    suspected) of Ebola virus disease (EVD) reported
    in the Democratic Republic of the Congo,
    including eight among healthcare workers (HCWs)
  • In total, 49 deaths have been reported, including
    eight among HCWs. 852 contacts have now completed
    21-day follow-up
  • Of 269 contacts currently being monitored, all
    (100) were seen on 9 October, the last date for
    which data has been reported.
  • The last confirmed case was isolated on 4 October
  • This outbreak is unrelated to that affecting
    Guinea, Liberia, Nigeria, Sierra Leone, Spain,
    and the United States of America.

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Situation report 20th October 2014
  • In Nigeria, all 891 contacts have now completed
    21-day follow-up (362 contacts in Lagos, 529
    contacts in Port Harcourt).
  • A second EVD-negative sample was obtained from
    the last confirmed case on 8 September (39 days
    ago)
  • In Senegal, a second EVD-negative sample was
    obtained from the single confirmed case on 5
    September (42 days ago)
  • WHO officially declares the Ebola outbreak in
    Senegal over on 17th October 2014
  • In Spain, 72 people, including 13 high-risk
    contacts, are being monitored.
  • In the United States of America, 125 contacts are
    being monitored.

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Consequences of EVD
  • Global pandemic - The combination of modern
    health systems and the limited communicability of
    the virus make it unlikely to spread in developed
    countries.
  • Political right and freedom On Aug. 6, Liberian
    President Ellen Johnson Sirleaf declared a
    national emergency and suspended constitutional
    rights for a 90-day period, citing unrest that
    represents a clear and present danger to the
    country.
  • Social - The virus has torn an already fragile
    society in affected countries damaged from years
    of civil war
  • Health system overwhelmed resources and
    infrastructure, loss of valuable human resource
  • Economy loss of revenue (tourism, trade,
    agriculture)
  • Future of the impact medical waste scavenging
    and wildlife migration, bioterrorism, national
    debt, political, economic and social instability,
    threat to national security

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Management of Ebola Virus Disease(EVD)
  • Dr. Halima Bello-Manga
  • Department of Haematology

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Management of EVD
  • The management of EVD is hinged on the following
    principles
  • Proper history and Physical Examination
  • Lab investigation(diagnosis).
  • Supportive therapy

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Medical History
  • EVD in its initial phase mimicks many other
    febrile illnesses e.g. malaria, common cold,
    typhoid fever, thus a high index of suspicion has
    to be shown.
  • A history of exposure to the disease in the last
    2-21 days prior to the onset of symptoms should
    be established.
  • Exposure could be in the form of
  • Contact with a person diagnosed with the disease
    e.g. caring for, visiting or even a attending the
    burial of an infected person. (Patients at risk
    include health care workers, family and friends,
    traditional healers, morticians, etc)
  • Hx of contact with contaminated materials used
    by a patient diagnosed with the disease, e.g. bed
    linen, eating utensils, medical equipment, etc.

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Medical History Contd
  • Contact with infected animals e.g
    apes/chimpanzees, fruit bats, pigs ( especially
    during processing) or eating.
  • History of travel to endemic areas or contact
    with someone with a hx of travel to such areas.

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Diagnosis
  • Once a case of EVD is suspected, the person is
    isolated and samples are sent for diagnosis.
    Samples are considered highly infectious and
    should be treated as such.
  • Diagnostic investigations include
  • ELISA ( Ag capture, IgM Antibody)
  • RT-PCR (confirmatory)
  • IgM and IgG detection
  • Virus isolation ( cell culture)
  • Electron microscopy
  • Immunohistochemistry( esp at post mortem).

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Treatment
  • There is no specific treatment medicine/drug or
    vaccine for EVD. (those available are in the
    trial phase) thus, the hallmark for the Rx of the
    Dx remains SUPPORTIVE, which include
  • Provision of IV fluids and correcting electrolyte
    imbalances.
  • Maintaining Oxygen saturation and blood pressure.
  • Treating other secondary infections with
    antimicrobials.
  • Good nutrition.
  • Use of anticoagulants in cases of DIC.

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Treatment Contd
  • Blood transfusion ( blood from patients that have
    recovered from EVD) seems to help and the WHO has
    approved its use in the treatment of patients.
  • In addition to the above, in actively bleeding
    patients with DIC, blood transfusion is used in
    replacing clotting factors, red cells and
    platelets( esp if component transfusion is done).
  • Psychological support is a very important aspect
    in the mx of ebola as the dx is associated with a
    lot of fear and anxiety because of its high
    mortality rate.

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Prognosis
  • EVD has a very high fatality rate of up to 90
    (when little or no medical intervention is
    instituted), with supportive care, it reduces to
    about 50 or lower with early appropriate
    intervention

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Glimpses of Hope
  • The current outbreak has caused a heightened
    international response towards this emerging
    disease and the world (mostly 1st world) has
    swung into action towards getting a cure for the
    disease.
  • The experimental drug ZMapp seems to be effective
    in the treatment. ( not available for use now).
  • At least 10 drugs and 2 vaccines against Ebola
    Virus dx are currently under development (WHO).

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Prevention and Control
  • Dr. Faruk Adiri
  • Department of Community Medicine

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Community Prevention and Control
  • Wash your hands regularly and properly use
    soap, disinfectant hand sanitizers
  • Avoid physical contacts (hand shake, hugging,
    kissing)
  • DO NOT touch, wash or kiss an infected person/
    dead body
  • Avoid their body fluids, including blood, vomit,
    faeces, urine
  • DO NOT touch or eat bush meat and dont eat
    bats
  • Cook animal product thoroughly

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Community prevention and Control
  • Call your medical centre early and tell them
    about your illness
  • Listen to the advice/key messages.
  • You may be sent to a special hospital
  • Keep away from others so they dont get sick
  • Be especially careful of your vomit and diarrhoea
  • Safe burial practices
  • Practice general sanitation/hygiene

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Prevention and Control-Animals
  • During outbreaks quarantine premises/farms
    affected
  • PPE while handling animals
  • Cull infected animals
  • Incineration of carcasses
  • Supervise burials closely
  • Ban movements and sale of infected animals from
    affected areas
  • Active animal health surveillance

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Prevention and Control-Humans
  • Raise awareness with key messages
  • Avoid close contact (within 1 meter)
  • Proper hand washing
  • PPE while handling patients
  • Standard precaution/procedure for infection
    control
  • Safe burial practice (incineration)

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Principles of Prevention
  • Contact tracing
  • Active case management
  • Surveillance

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Conclusion
  • Ebola, supposedly does not travel through the
    air, making it harder to transmit than other
    pathogens that cause epidemics such as the
    Influenza virus.
  • It has been established that with good health
    care practices, the disease can be contained and
    may not be as vicious a killer as other
    infections that have bedeviled us in the past.
  • The Flu virus kills up to ½ a million every year
    and even as high as 50 million during the great
    pandemic of 1917-1918, not to mention emerging
    infectious diseases like resistant tuberculosis,
    and even severe antibiotic resistance that has
    now become a huge public health issue.
  • So it is extremely important that we do not panic
    as fear can drive sick people underground making
    contact tracing impossible and aiding the spread
    to unaffected areas.

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Conclusion
  • The present outbreak started in Guinea and
    quickly spread to two other West African
    countries which are about the poorest on earth.
  • These countries are all inundated with poor
    health care, resulting in challenges that are
    probably too heavy for them to bear.
  • These, accompanied with the biases and prejudices
    of the local populations, have made responses
    inadequate resulting into what we have today.
  • It may be necessary to involve All concerned,
    like, community leaders, religious gurus and
    even traditional healers for effective
    intervention as long as they are aware of the
    risks of Ebola as good healers are skillful in
    conceiving and promoting therapies that intervene
    in the dynamics of biological diseases and human
    relationships

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Conclusion
  • Prof Langwick of Cornell University said that
    when people live in an area with poor health
    facilities surrounded by death and fear of death,
    it is an infuriating and terrifying situation
    which can result in desperation.
  • This desperation can result in distrust and
    violence as happened recently in Liberia.
  • How we care for our people especially in the face
    of danger is very important and Prof Langwick
    described it very appropriately as the ethics of
    living, the ethics of caring.
  • This is the time to act and be prepared.

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Conclusion
  • As yet, we are lucky that Ebola is not in this
    part of the country. So what is important now is
    for us to prevent it from getting here and
    prepare for how we will control it if and when it
    eventually gets here.
  • We can play our parts by educating ALL around us,
    in our homes, classes, religious settings etc
    etc.
  • Correct politely, bad habits like spitting,
    sneezing without covering the mouth and blowing
    of the nose publicly, and teach people about
    basic infection control themes like washing hands
    properly.
  • Emphasis must be placed on how this disease is
    transmitted especially amongst sick family
    members and about safe burial practices.

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Conclusion
  • We must not let what happened in Liberia Guinea
    and Sierra Leone be repeated here.
  • Plan, Plan Plan. Identify health workers
    including epidemiologists that will be capable of
    dealing with the situation
  • PPE and other essentials must be provided
    adequately. So also we must have ambulances, and
    even train specially those who will undertake
    burials.
  • Link with local Government council chairmen so as
    to avoid shadow zones
  • Data collection is extremely important and
    epidemiological surveillance must be instituted.

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Conclusion
  • Interestingly, caregivers at the front line bear
    the brunt of this dreadful disease- a sobering
    fact being the demise of the five co-authors of
    an Ebola genome analysis study who died before
    even the publication of their work.
  • The research project published in the JOURNAL OF
    SCIENCE sequenced the Ebola genome thus paving
    way for plotting mutation and thereby finding the
    origin of the virus.
  • The research has provided data about how the
    virus operates and hopefully will help in the
    development of effective drugs and vaccines.
  • We must salute these fellows, MBALU FONNIE, ALEX
    MOGBOI, ALICE KOROMA, MOHAMMED FULLAH AND SHEIK
    HUMARR KHAN who died in the process of finding
    solution to the problem of Ebola.
  • Coming nearer home, we must salute our health
    care workers like Dr Stella Adadevoh and others
    who lost their lives in the process of treating
    the Index case Patrick Sawyer..

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Conclusion
  • In a video which appeared in the White House
    website and was aimed at West African countries
    struggling with the outbreak, President Obama
    said Stopping this disease wont be easy. But we
    know how to do it. You are not alone, together we
    can treat those who are sick with respect and
    dignity. We can save lives and our countries can
    work together to improve Public Health so this
    kind of outbreak doesnt happen again
  • AND FINALLY

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  • LET US ALL PREVENT EBOLA

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Acknowledgement
  • The organizations and authors of reports and
    information we cited for the development of this
    presentation
  • World Health Organization Global Alert and
    Response (GAR) Situation Reports
  • World Health Organization Disease Outbreak News
    (DON)
  • World Health Organizations Epidemic and Pandemic
    Alert and Response (EPR)
  • Guinea Ebola epidemic declared, MSF launches
    emergency response
  • http//www.cdc.gov/vhf/ebola/outbreaks/2014-west-a
    frica/case-counts.html
  • http//apps.who.int/iris/bitstream/10665/136645/1/
    roadmapupdate17Oct14_eng.pdf?ua1
  • http//www.who.int/csr/disease/ebola/en/
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