Based on recent outbreak in West Africa. Level- For Undergraduates

1. Ebola virus disease
Fact sheet N°103
Updated April 2014

4. The Ebola outbreak in West Africa has prompted health
authorities in other countries to take precautions beyond
experts' recommendations, showing the concern about the
deadly disease.

5. WHO: Disease update
• The magnitude of the Ebola virus outbreak may
be vastly underestimated, the World Health
Organization said on Thursday 14 Aug 14.
• . More than 1,000 people have died and nearly
2,000 have been sickened.

6. WHO: Disease update
• They say the deadly nature of Ebola, which has
killed 54% of those infected in the current
outbreak and up to 90% in other outbreaks, and
concerns from the public justify the precautions.
• Reports of possible cases from New York City to
Hong Kong have alarmed some in the public,
though fears subsided somewhat after all tested
negative.

7. BUSINESS
• Tekmira Evaluating Options for Using Experimental Ebola
Virus Drug
• Canadian Firm in Talks With Agencies on Using Drug
Despite Lack of Regulatory Approval
By MARIA ARMENTAL
CONNECT
Updated Aug. 14, 2014 8:30 a.m. ET
• Tekmira Pharmaceuticals Corp. on Wednesday said it is
looking into ways that its experimental Ebola treatment
might be used to combat a serious outbreak in West
Africa, even if the drug hasn't been formally cleared by
the various regulatory agencies.
• "Given the severity of the situation, we are carefully
evaluating options for use of our investigational drug
within accepted clinical and regulatory protocols," the
company said. "This includes discussions with
government agencies and NGO's, including the…

8. WORLD NEWS
• Ebola Virus: Nigerian Patients to Be Given Experimental Drug
• Untested Drug on Way to Lagos to Treat Eight Nigerians
• Ebola victims in Nigeria's commercial capital Lagos will
receive an experimental drug called Nano Silver and ZMapp
the country's top health official said on Thursday,
• Nigerian scientist, whose name he wouldn't disclose.
• The World Health Organization opened the door for
experimental Ebola drugs this week, after a panel of ethicists
it convened, condoned such treatments because of the
challenges controlling an outbreak that has killed at least
1,069 people. A handful of medications and vaccines have
been developed, but not tested on humans.

9. Sheik Umar Khan, head
doctor fighting the deadly
tropical virus Ebola in
Sierra Leone, poses for a
picture in Freetown, June
25, 2014.
Khan, a Sierra Leonean
virologist credited with
treating more than 100
Ebola victims, contracted
the disease a month later
and died on July 29.
(Umaru Fofana / Reuters)

11. Key Facts?

12. Key facts
• Ebola virus disease (EVD), formerly known as
Ebola haemorrhagic fever, is a severe, often fatal
illness in humans.
• EVD outbreaks have a case fatality rate of up to
90%.
• EVD outbreaks occur primarily in remote villages
in Central and West Africa, near tropical
rainforests.
• The virus is transmitted to people from wild
animals and spreads in the human population
through human-to-human transmission.

13. Key facts
• Fruit bats of the Pteropodidae family are
considered to be the natural host of the Ebola
virus.
• Severely ill patients require intensive supportive
care.
• No licensed specific treatment or vaccine is
available for use in people or animals.

14. Natural host of Ebola virus
• In Africa, fruit bats, esp species of the genera
–Hypsignathus monstrosus,
–Epomops franqueti and
–Myonycteris torquata,
are considered possible natural hosts
• As a result, the geographic distribution of Ebola
viruses may overlap with the range of the fruit
bats.

15. History
• Ebola first appeared in 1976 in 2 simultaneous
outbreaks, in Nzara (Sudan), and Yambuku
(Democratic Republic of Congo).
• The latter was in a village situated near the
Ebola River, from which the disease takes its
name.

16. Using a Tactic Unseen in a Century-
Countries Cordon Off Ebola-Racked Areas

17. Ebola
• The phrase cordon sanitaire, or sanitary
barrier, appears to date from 1821, when
France sent 30,000 troops into the Pyrenees
to stop a lethal fever raging in Spain from
crossing the border.

18. cordon sanitaire
• Plans for the new cordon were announced Aug. 1
at an emergency meeting in Conakry, Guinea, of
the Mano River Union, a regional association of
Guinea, Sierra Leone and Liberia, the three
countries hardest hit by Ebola.
• Armed forces have been put in place.
• Informers maybe paid.
• WHO and other countries with a vote have urged
it to proceed in a humane manner

19. • The most famous voluntary cordon, according to
Joseph P. Byrne, a historian at Belmont University in
Nashville, Tennessee, was of the English village of
Eyam. In 1665, the plague reached it from London,
probably in fleas on cloth shipped to a local tailor,
the first to die.
• The village, which had about 350 people, voluntarily
cordoned itself off from the spring until November to
prevent the plague from spreading to the rest of
Derbyshire.
• Grateful people from other villages left food outside
a circle of stones around Eyam. Only a quarter of the
village survived, but the plague did not spread.

20. Taxonomy: Family Filoviridae
has 3 genuses
• Ebolavirus
• Marburgvirus
• Cuevavirus
Genus Ebolavirus comprises 5 distinct species:
–Bundibugyo ebolavirus (BDBV)
–Zaire ebolavirus (EBOV)
–Reston ebolavirus (RESTV)
–Sudan ebolavirus (SUDV)
–Taï Forest ebolavirus (TAFV).

21. Taxonomy: Family Filoviridae
Genus Ebolavirus comprises 5 distinct species:
–Bundibugyo ebolavirus (BDBV) **
–Zaire ebolavirus (EBOV) **
–Reston ebolavirus (RESTV)
–Sudan ebolavirus (SUDV) **
–Taï Forest ebolavirus (TAFV).
** Ass with large outbreaks in Africa

22. World Distribution
• BDBV, EBOV, and SUDV have been associated
with large EVD outbreaks in Africa, whereas
RESTV and TAFV have not.
• 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.

24. Transmission
• 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.

25. Transmission
Ebola then spreads by human-to-human
transmission in the community
• Direct contact of broken skin or mucous
membranes with the blood, secretions, organs or
other bodily fluids of infected people
• Indirect contact with environments
contaminated with such fluids. At burial
ceremonies mourners having direct contact with
the dead body can transmit Ebola.
• Men can still transmit the virus through their
semen for up to 7 weeks after recovery from
illness.

26. Transmission
• Health-care workers have frequently been
infected while treating patients with suspected
or confirmed EVD. This has occurred through
close contact with patients when infection
control precautions are not strictly practiced.

27. Transmission
• Among workers in contact with monkeys or pigs
infected with Reston ebolavirus, several
infections have been documented in people who
were clinically asymptomatic.
• Thus, RESTV appears less capable of causing
disease in humans than other Ebola species.

28. Transmission
Reston ebolavirus -milder disease?
• However, the only available evidence comes from
healthy adult males.
• It is premature to extrapolate the health effects
other population groups -
–immuno-compromised persons
–underlying medical conditions
–pregnant women and children
• More studies are needed before conclusions about
pathogenicity & virulence of RESTV

29. Incubation Period
• The incubation period, that is, the time interval
from infection with the virus to onset of
symptoms, is 2 to 21 days.
• People are infectious as long as their blood and
secretions contain the virus.
• Ebola virus was isolated from semen 61 days
after onset of illness in a man who was infected
in a laboratory.

30. Signs and symptoms
EVD is a severe acute viral illness characterized by
• sudden onset of fever
• intense weakness and muscle pain
• headache and sore throat.
Followed by-
• vomiting and diarrhoea
• Rash
• both internal and external bleeding.
• Deranged kidney & liver functions in some cases

31. Signs and symptoms
EVD is a severe acute viral illness characterized by
• sudden onset of fever
• intense weakness and muscle pain
• headache and sore throat.
Followed by-
• Vomiting and diarrhoea
• Rash
• Both internal and external bleeding.
• Deranged kidney & liver functions in some cases

32. Fever, dehydration

33. Hemorrhagic bullae

34. Hemorrhagic bullae

35. Laboratory findings
• Low white blood cell
• Low platelet counts
• Elevated liver enzymes

36. Differential Diagnosis
Other diseases that should be ruled out are-
• Malaria
• Typhoid fever
• Shigellosis
• Cholera
• Leptospirosis
• Plague
• Rickettsiosis
• Relapsing fever
• Meningitis
• Hepatitis
• Other viral haemorrhagic fevers

37. Diagnosis
Definitive lab diagnosis is by several tests:
• antibody-capture ELISA
• antigen detection tests
• serum neutralization test
• RT-PCR assay
• electron microscopy
• virus isolation by cell culture.
Samples from patients are an extreme biohazard
risk; testing should be conducted under
maximum biological containment conditions.

38. Vaccine and treatment
• No licensed vaccine for EVD is available. Several
vaccines are being tested, but none are available
for clinical use.
• Severely ill patients require intensive supportive
care.
• Patients are frequently dehydrated and require
oral rehydration with solutions containing
electrolytes or intravenous fluids.
• No specific treatment is available.
• New drug therapies are being evaluated. Z Mapp

39. Ebola virus in animals
• Non-human primates have been a source of
infection for humans, they are the reservoir but
rather accidental host like human beings. Since
1994, ebola outbreaks (EBOV and TAFV sps) have
been observed in chimpanzees and gorillas.
• RESTV has caused severe outbreaks in macaque
monkeys farmed in Philippines and detected in
monkeys imported into the USA & Italy from 1989
to 1996.

40. Ebola virus in animals
• Since 2008, RESTV viruses have been detected
during deadly outbreaks in pigs in China and
Philippines.
• Asymptomatic infection in pigs has been reported.
• But, experimental inoculations have shown that
RESTV cannot cause disease in pigs.

41. Prevention and control
Controlling Reston ebolavirus in domestic animals
• No animal vaccine against RESTV is available.
• Routine cleaning and disinfection of pig or
monkey farms (sodium hypochlorite or other
detergents) should inactivate the virus.
• If an outbreak is suspected, the premises should
be quarantined immediately.
• Culling of infected animals.
• Close supervision of burial /incineration of
carcasses.
• Restricting or banning the movement of animals
from infected farms to reduce spread.

42. Proper burial of carcasses

43. Prevention and control
Controlling Reston ebolavirus in domestic animals
• RESTV outbreaks in pigs and monkeys have
preceded human infections.
• Establishment of an active animal health
surveillance system to detect new cases (early
warning) for public health authorities.

44. Prevention and control
Reducing the risk of Ebola infection in people
• In the absence of effective treatment and a
human vaccine, 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.
• During EVD outbreaks, educational public health
messages for risk reduction must focus on
several factors:

45. Prevention and control
Reducing the risk of Ebola infection in people
A. Reducing the risk of wildlife-to-human
transmission from
• Avoid contact with infected fruit bats or
monkeys/apes.
• Avoid consumption of their raw meat.
• Handling animals with gloves and protective
clothing.
• Thorough cooking of animal products (blood
and meat) before consumption.

46. Prevention and control
B. Reducing the risk of human-to-human
transmission
• Risk arises from direct /close contact with infected
patients, and 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.

47. Protective gear- in hospitals

48. … and at home

49. Prevention and control
B. Reducing the risk of human-to-human
transmission
• Regular hand washing before and after taking care
of patients at home.
• Affected communities should inform the whole
population about nature of the disease and
containment measures, including burial of the
dead.
• People who have died from Ebola should be
promptly and safely buried.

50. Safe burials

51. Prevention and control
Reducing the risk of Ebola infection in people
• Pig farms in Africa can amplify infection due to
fruit bats on these farms.
• Appropriate biosecurity measures should limit
transmission.

52. Prevention and control
Reducing the risk of Ebola infection in people
• For RESTV, educational public health messages should
focus on reducing the risk of pig-to-human transmission.
• Avoid unsafe animal husbandry, slaughtering practices,
consumption of fresh blood, raw milk or animal tissue.
• Use gloves and other protective clothing when handling
sick animals or their tissues and when slaughtering animals.
• Thorough cooking before eating all animal products (blood,
meat and milk) in regions where RESTV has been reported
in pigs

53. Infection Control: in health-care settings
• Human-to-human transmission is associated
with direct or indirect contact with blood and
body fluids.
• Transmission to health-care workers has been
reported when appropriate infection control
measures have not been observed.
• It is not always possible to identify patients
with EBV early because initial symptoms may
be non-specific.

54. Infection Control: in health-care settings
• For this reason, 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 (according to the risk of splashes
or other contact with infected materials), safe
injection practices and safe burial practices.

55. Infection Control: in health-care settings
• Health-care workers caring for suspected or
confirmed Ebola cases should apply, in addition to
standard precautions, other infection control
measures to avoid any exposure to the patient’s
blood and body fluids and direct unprotected
contact with the possibly contaminated
environment.
• 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).

57. Infection Control: in health-care settings
• 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.

58. WHO response
• WHO provides expertise and documentation to
support disease investigation and control.
• Recommendations for infection control while
providing care to patients with suspected or
confirmed Ebola haemorrhagic fever are
provided in: Interim infection control
recommendations for care of patients with
suspected or confirmed Filovirus (Ebola,
Marburg) haemorrhagic fever, March 2008. This
document is currently being updated.

59. Much worse maybe ahead...