EBOLA VIRUS ALERT

1. Presented by: DR S.D SHEKDE

3. EBOLA VIRUS
• Presented by
Dr.S.D.Shekde
JR 2
• Guided by
DR. V. M.HOLAMBE
H.O.D.
Assist. Professor
Dept Of Comm. Medicine
G.M.C. LATUR
Date-30/08/14

4. INTRODUCTION
 Ebola first appeared in 1976 in 2 simultaneous
outbreaks, in Nzara, Sudan, and in Yambuku,
Democratic Republic of Congo.
 The latter was in a village situated near the Ebola River,
from which the disease takes its name.
 Fruit bats of the Pteropodidae family are considered to
be the natural host of the Ebola virus.

5. INTRODUCTION
 Ebola first appeared in 1976 in 2 simultaneous
outbreaks, in Nzara, Sudan, and in Yambuku,
Democratic Republic of Congo.
 The latter was in a village situated near the Ebola River,
from which the disease takes its name.
 Fruit bats of the Pteropodidae family are considered to
be the natural host of the Ebola virus.

6. VIRUS CLASSIFICATION
 Genus Ebolavirus is 1 of 3 members of the Filoviridae
family ( filovirus),
along with genus Marburg virus and genus Cueva
virus.
 Group: Group V (-)ssRNA
Order: Mononegavirales
Family: Filoviridae
Genus:Ebolavirus

7. SPECIES
 Genus Ebolavirus comprises 5 distinct species:
 Bundibugyo ebolavirus (BDBV)
 Zaire ebolavirus (EBOV)
 Sudan ebolavirus (SUDV)
 Reston ebolavirus (RESTV)
 Taï Forest ebolavirus (TAFV).
Outbreaks
of AFRICA
 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.

8. The Zaire ebolavirus is the most dangerous
of the five species of Ebola viruses of the
Ebolavirus genus which are the causative
agents of Ebola virus disease.(EVD)
The virus causes an extremely
severe hemorrhagic fever in humans and
other primate.

9. The name Zaire ebolavirus is derived from Zaire,
the country (now the Democratic Republic of
Congo) in which the Ebola virus was first
discovered) and the taxonomic suffix ebola
virus (which denotes an ebola virus species).

10. VIRION STRUCTURE

11.  The EBOV genome is approximately 19 kb in length. It
encodes seven structural proteins:
 nucleoprotein (NP)
 polymerase cofactor (VP35), (VP40)
 GP
 transcription activator (VP30), VP24
 RNA polymerase (L)

12.  The tubular Ebola virions are generally 80 nm in
diameter and 800 nm long. In the center of the
particle is the viral nucleocapsid which consists of the
helical ssRNA genome wrapped about the NP, VP35,
VP30 and L proteins.
 This structure is then surrounded by an outer viral
envelope derived from the host cell membrane that is
studded with 10 nm long viral glycoprotein (GP)
spikes. Between the capsid and envelope are viral
proteins VP40 and VP24 .

13.  This envelope GP spike is expressed at the cell surface,
and is incorporated into the virion to drive viral
attachment and membrane fusion.
 It has also been shown as the crucial factor for Ebola
virus pathogenicity .
 GP is actually post-translationally cleaved by the
proprotein convertase furin to yield disulphide-linked
GP1 and GP2 subunits.

14.  GP1 allows for attachment to host cells, while GP2
mediates fusion of viral and host membranes.
 This protein assembles as a trimer of heterodimers on
the viral envelope, and ultimately undergoes an
irreversible conformation change to merge the two
membranes

15. Pathophysiology

16.  Endothelial cells, mononuclear phagocytes,
and hepatocytes are the main targets of infection. After
infection, a secreted glycoprotein (sGP) known as the Ebola
virus glycoprotein (GP) is synthesized.
 Ebola replication overwhelms protein synthesis of infected
cells and host immune defenses.
 The GP forms a trimeric complex, which binds the virus to
the endothelial cells lining the interior surface of blood
vessels.

17.  The sGP forms a dimeric protein that interferes with the
signaling of neutrophils, a type of white blood cell, which
allows the virus to evade the immune system by inhibiting
early steps of neutrophil activation.
 These white blood cells also serve as carriers to transport the
virus throughout the entire body to places such as the lymph
nodes, liver, lungs, and spleen.

19. EPIDEMIOLOGY

20. http://www.cdc.gov/vhf/ebola/resources/distribution-map.html

21. Current Ebola Outbreak in West
Africa
 The current (2014) Ebola outbreak is occurring in the
following West African countries:
 Guinea
 Liberia
 Sierra Leone
 Nigeria

26. • The virus is transmitted to people from wild animals and spreads in the
human population through human-to-human transmission.
• EVD outbreaks occur primarily in remote villages in Central and West Africa,
near tropical rainforests.
AlvinChew slideshare presentation
alvinworks2006@yahoo.com

27. TRANSMISSION
•The virus is spread through direct
contact (through broken skin or
mucous membranes) with
i. sick person's blood or body fluids
(urine, saliva, feces, vomit, sweat
and semen)
ii. objects (such as needles) that have
been contaminated with infected
body fluids.
iii. Infected animals.

28.  Exposure to ebola viruses can occur in healthcare
settings where hospital staff are not wearing
appropriate protective equipment, such as masks,
gowns, and gloves.
 Proper cleaning and disposal of instruments, such
as needles and syringes, is also important.

29. Transmission
Animal to
human
• Consumption of
raw meat
• Contact wit fruit
bat, pigs, apes-animal
handlers
• Animal products
(blood, urine and
feces.)
Human to
human
• Close contact
with infected
patients
• Care personnels
of patient
• Health care
workers
Prompt and safe
burial of dead
bodies.
No to Autopsy
Virus contained
in dead body for
a period 4 weeks.

30.  Men who have recovered from the illness can still
spread the virus to their partner through their semen
for up to 7 weeks after recovery.
 Burial ceremonies in which mourners have direct
contact with the body of the deceased person have
played a role in the transmission of Ebola.

31. 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; and
 Mourners who have direct contact with the bodies of
the deceased as part of burial ceremonies.

32. Ebola Virus Disease

33. SUDDEN ONSET FEVER SORE THROAT
INTENSE WEAKNESS MUSCLE PAIN, HEADACHE
VOMITTING RASH
DIARRHOEA IMPAIRED KIDNEY AND
RENAL FUNCTION
LAB
•LOW WBC
•LOW PLATELET
•ELEVATED
LIVER ENZYMES.

34.  In some cases, both internal and external bleeding.
 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.
 The incubation period, that is, the time interval from
infection with the virus to onset of symptoms, is 2 to 21
days.

35.  The patient becomes contagious once they begin to
show symptoms. They are not contagious during the
incubation period.
 Ebola virus disease infections can only be confirmed
through laboratory testing.

36. AlvinChew slideshare presentation
alvinworks2006@yahoo.com

39.  In some cases, both internal and external bleeding.
 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.
 The incubation period, that is, the time interval from
infection with the virus to onset of symptoms, is 2 to 21
days.

41. Person Under Investigation (PUI)
 A person who has both consistent symptoms and risk
factors as follows:
 1) Clinical criteria, which includes fever of greater than
38.6 degrees Celsius or 101.5 degrees Fahrenheit, and
additional symptoms such as severe headache, muscle
pain, vomiting, diarrhea, abdominal pain, or
unexplained hemorrhage.

42. 2) Epidemiologic risk factors within the
past 21 days before the onset of symptoms, such as
contact with blood or other body fluids or human
remains of a patient known to have or suspected to
have EVD;
 residence in—or travel to—an area where EVD
transmission is active. or direct handling of bats,
rodents, or primates from disease-endemic areas.

43. Probable Case
 A PUI who is a contact of an EVD case with either a
high or low risk exposure.
Confirmed Case
 A case with laboratory confirmed diagnostic evidence
of ebola virus infection.

44. Contacts of an EVD Case
(LEVELS OF EXPOSURE)
High risk exposures
 Percutaneous, e.g. the needle stick, or mucous
membrane exposure to body fluids of EVD patient.
 Direct care or exposure to body fluids of an EVD
patient without appropriate personal protective
equipment (PPE)
 Laboratory worker processing body fluids of
confirmed EVD patients without standard biosafety
precautions.

45. Low risk exposures
 Household member or other casual contactwith an
EVD patient
 Providing patient care or casual contact without high-risk
exposure with EVD patients in health care
facilities in EVD outbreak affected countries
No known exposure
Persons with no known exposure in an EVD outbreak
affected country in the past 21 days with no low risk or
high risk exposures.

46. DIFFERENTIAL DIAGNOSIS
 Malaria
 Dengue
 Typhoid fever
 Shigellosis
 Cholera
 Leptospirosis
 Rickettsiosis
 Relapsing fever
 Other viral haemorrhagic fevers.

47. DIAGNOSIS
 Ebola virus infections can be diagnosed in a
laboratory through several types of tests:
 Antibody-capture enzyme-linked immunosorbent
assay (ELISA) -NP is one of the major viral structural
components
 Antigen detection tests
 Serum neutralization test
 Reverse transcriptase polymerase chain reaction (RT-PCR)
assay
 Electron microscopy
 Virus isolation by cell culture.

48.  Samples from patients are an extreme biohazard risk;
testing should be conducted under maximum
biological containment conditions.

49. CDC- Diagnosis
Timeline of Infection Diagnostic tests available
Within a few days after symptoms begin
•Antigen-capture enzyme-linked
immunosorbent assay (ELISA) testing
•IgM ELISA
•Polymerase chain reaction (PCR)
•Virus isolation
Later in disease course or after recovery •IgM and IgG antibodies
Retrospectively in deceased patients
•Immunohistochemistry testing
•PCR
•Virus isolation

50. When Specimens Should Be
Collected for Ebola Testing
 Ebola virus is detected in blood only after onset of
symptoms, most notably fever.
 It may take up to 3 days post-onset of symptoms for
the virus to reach detectable levels.
 Virus is generally detectable by real-time RT-PCR
from 3-10 days post-onset of symptoms, but has been
detected for several months in certain secretions.

51.  Specimens ideally should be taken when a
symptomatic patient reports to a healthcare facility
and is suspected of having an EVD exposure
 However, if the onset of symptoms is <3 days, a
subsequent specimen will be required to completely
rule-out EVD.

52. From whom the samples are to be
collected?
 The samples should be collected from any person ill or
deceased who has or had fever with acute clinical
symptoms and signs of hemorrhage, such as bleeding
of the gums, nose-bleeds, conjunctival injection, red
spots on the body, bloody stools and/or melaena
(black liquid stools), or vomiting blood
(haematemesis) with the history of travel to the
affected area.

53.  OR
 Any person (living or dead) having had contact with a
clinical case of EBVD and with a history of acute fever.
 Anyone who has accidently come in contact with
blood or body fluids should be kept under quarantine
and observed for 30 days.

54. Preferred Specimens for Ebola Testing
 A minimum volume of 4mL whole blood / serum/
plasma preserved with EDTA, clot activator, sodium
polyanethol sulfonate (SPS), or citrate
in plastic collection tubes can be submitted for EVD
testing.
 Postmortem: Tissue sample (liver, spleen, bone
marrow, kidney, lung and brain)

55.  Do not submit specimens preserved in heparin tubes.

 Specimens should be stored at 4°C or frozen.
 Before dispatching the sample disinfect the outer
surface of container using 1:100 dilution of bleach or
5% Lysol solution.

56. Transporting Specimens within the Hospital /
Institution
 Specimens should be placed in a durable, leak-proof
secondary container for transport within a facility.
 To reduce the risk of breakage or leaks, do not use any
pneumatic tube system for transporting suspected
EVD specimens.

57.  Samples should be sent to the following laboratories
under cold chain with prior intimation:
 National Institute of Virology, Pune.
 National Centre for Disease Control, Delhi.

58. TREATMENT

59. No ebola virus Disease-specific
treatment exists.
Treatment is primarily supportive in nature
and includes minimizing invasive procedures,
balancing fluids and electrolytes to
counter dehydration

60.  Administration of anticoagulants early in
infection to prevent or control disseminated
intravascular coagulation,
 Administration of procoagulants late in infection
to control bleeding.
 maintaining oxygen levels, pain management, and
the use of medications to treat bacterial or fungal
secondary infections.

61. Early treatment may increase the
chance of survival.
A number of experimental treatments
are being studied

62. A hospital isolation ward in Gulu, Uganda,
during the October 2000 outbreak

63.  a high fatality rate for this
disorder (80% to 90%)
mortality from Ebola has ranged
from 25% to 90% and recovery is
slow in those who survive.
Morbidity and mortality rates are
very high, and they vary with the
strain of Ebola

64. The most highly lethal Ebola subtype
is EBO-Z, which has been reported to
have a mortality rate as high as 88%.
The EBO-S subtype has a reported
mortality rate of 50%, similar to that of
the Ebola outbreak in Gabon, where the
mortality rate was 57-66%.

65. Vaccine:
 No vaccine is currently available for humans.
 The most promising candidates are DNA vaccines or vaccines
derived from adenoviruses, vesicular stomatitis Indian virus
(VSIV) or filovirus-like particles (VLPs)because these
candidates could protect nonhuman primates from
ebolavirus-induced disease. DNA vaccines, adenovirus-based
vaccines, and VSIV-based vaccines have entered clinical
trials.
 Vaccines have protected nonhuman primates.

66. PREVENTION:___

68. PREVENTION: A poster, among those being
distributed by UNICEF, bears information
and illustrations on the symptoms of Ebola
virus disease (EVD)

69. Prevention:
Prevention focuses on avoiding contact with
the viruses. The following precautions can
help prevent infection and spread of Ebola
•Avoid areas of known outbreaks.
•Wash your hands frequently. As with other infectious
diseases, one of the most important preventive measures is frequent
hand-washing. Use soap and water, or use alcohol-based hand rubs
containing at least 60 percent alcohol when soap and water aren't
available.

70. • Avoid wildlife /bush meat. In developing
countries, avoid buying or eating the wild animals,
including nonhuman primates, sold in local
markets.
• Avoid contact with infected people. In
particular, caregivers should avoid contact with the
person's body fluids and tissues, including blood,
semen, vaginal secretions and saliva.
 People with Ebola are most contagious in the
later stages of the disease.

71. •Follow infection-control procedures. If you're
a health care worker, wear protective clothing,
such as gloves, masks, gowns and eye shields. Keep
infected people isolated from others. Dispose of
needles and sterilize other instruments.
•Don't handle remains. The bodies of people who
have died of Ebola disease are still contagious.
Specially organized and trained teams should bury
the remains, using appropriate safety equipment.

72. Infection Control for Collecting and
Handling Specimens
 This includes wearing appropriate personal protective
equipment (PPE) and adhering to engineered safeguards,
for all specimens regardless of whether they are identified
as being infectious.
 Recommendations for specimen collection: full face
shield or goggles, masks to cover all of nose and mouth,
gloves, fluid resistant or impermeable gowns. Additional
PPE may be required in certain situations.

73. This picture taken on April 9, 2005 shows five
health workers, dressed in head-to-toe "Ebola
suits."
Doctors dressed up for Ebola in Bundibugyo

74. A researcher working with the Ebola virus while wearing
a BSL-4 positive pressure suit to avoid infection

75. Proper
Clothing

76. Recommendations for laboratory
testing
 full face shield or goggles
 masks to cover all of nose and mouth
 gloves
 fluid resistant or impermeable gowns
 use of a certified class II Biosafety cabinet or plexiglass
splash guard
 disinfectants routinely used to decontaminate the
laboratory environment (benchtops and surfaces) and
the laboratory instrumentation are sufficient to
inactivate enveloped viruses, such as influenza,
hepatitis C, and Ebola viruses.

77. PATIENT PLACEMENT
 Place the patient in Single room (containing a private
bathroom) with the door closed.
 Maintain a log of persons entering the patient’s room.
 Allow access to only those necessary for the patient’s well-being
and care, such as a child’s parent.
 Use of Personal Protective Equipment is essential.

78.  All persons entering the patient room should wear at
least:
o Gloves
o Gown (fluid resistant or impermeable)to cover
clothing and exposed skin
o Eye protection (goggles) to prevent splashes on eye.
o Facemask to prevent splashes on nose and mouth.
o Face shield, if used, will protect eye, nose and mouth.
o Closed shoes

79. Waste Management

80.  Waste should be segregated to enable appropriate and safe
handling.
 Sharp objects (e.g. needles, syringes, glass articles) and
tubing that has been in contact with the bloodstream
should be placed inside puncture resistant containers.
 These should be located as close as practical to the area in
which the items are used.
 Collect all solid, non-sharp, medical waste using leak-proof
waste bags and covered bins.

81. Waste should be placed in a designated pit of
appropriate depth (e.g. 2 m deep and filled to a
depth of 1–1.5 m). After each waste load the waste
should be covered with a layer of soil 10–15 cm
deep.
 Placenta and anatomical samples should be buried
in a separate pit or incinerated

82.  An incinerator may be used to destroy solid waste. However,
it is essential to ensure that total incineration has taken
place.
 The area designated for the final treatment and disposal of
waste should have controlled access to prevent entry by
animals, untrained personnel or children.

83. Waste, such as faeces, urine and vomit, and liquid
waste from washing, can be disposed of in the
sanitary sewer or pit latrine. No further treatment
is necessary.
Wear gloves, gown, closed shoes and goggles/facial
protection, when handling liquid infectious waste
(e.g. any secretion or excretion with visible blood
even if it originated from a normally sterile body
cavity). Avoid splashing when disposing of liquid
infectious waste

84.  Quarantine:
 Quarantine, also known as enforced isolation, is usually
effective in decreasing spread.
 Governments often quarantine areas where the disease is
occurring or individuals who may be infected.
 In the United States the law allows quarantine of those
infected with Ebola.
 The lack of roads and transportation may help slow the
disease in Africa.
 During the 2014 outbreak Liberia closed schools.

85. AlvinChew slideshare presentation
alvinworks2006@yahoo.com

86. Bioterrorism
 Locality of this virus has become less isolated as the
threat of bioterrorism looms large.
 The Ebola virus is now on the “A” list for hopeful
vaccination development.
 Experiments have even been formed to show how
Ebola can be used as a bioterror agent.

87. CURRENT STATISTICS- INDIA
 The Union Health Ministry on Wednesday (20-08-14) said
that there was no confirmed or even suspect case of Ebola
virus disease in India as yet.
 In a statement, the Ministry said that a 30-year-old Nigerian
national, who arrived at the Delhi Airport, was admitted to
Dr. RML Hospital on Wednesday morning with fever. He has
tested negative for Ebola at the National Centre for Disease
Control, Delhi. Mandatory reporting of passengers from
affected countries was in place.
 Since it began on August 10, about 3,089 passengers have
been screened at the airports at Delhi, Mumbai, Kolkata,
Bangalore, Chennai, Thiruvananthapuram and Kochi.

88. Conclusion
 EVD is very contagious.
 No aerosol route of transmission noted.
 Spreads through mucous membrane and contact with
body fluids.
 Contact tracing and isolation very important.
 Early detection of cases to improve curative rate.
 Supportive treatment.
 To follow WHO/CDC methods of prevention.

89. References
 http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebotabl.htm
 http://www.who.int/mediacentre/factsheets/fs103/en/
 http://mohfw.gov.in
 www.osha.gov
 Hampton, Tracy. Vaccines Against Ebola and Marburg Viruses Show
Promise in Primates Studies. Maedical News and Perspectives.
JAMA. Vol. 294 No. 2 July 2005.
 Jones, Steven. Live attenuated recombinant vaccine
protects nonhuman primates against Ebola and Marburg
viruses. Nature Medicine. Vol. 11 No. 7 July 2005.