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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 – PowerPoint PPT presentation

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Title: Ebola


1
Ebola
  • The Deadly
  • African Virus

Davood Yadegarinia Professor of Infectious
Diseases and Tropical Medicine Research Center,
Shahid Beheshti University of Medical Sciences
2
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

3
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

4
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
5
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
6
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
7
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

8
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.

9
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
10
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.
11
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.
12
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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14
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)

15
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.

19
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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20
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.

21
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

22
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
23
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

24
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

25
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

26
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27
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.

28
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
29
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

30
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.

31
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.

32
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

33
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

34
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.

35
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

36
PRECAUTIONS
  • Use Standard Precautions
  • Routine Hand washing
  • Handle and Dispose of Shar Instruments Safely
  • Cook meat thoroughly
  • Environment Cleaning

37
FIVE TYPES OF HAND HYGEINE
38
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

39
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