EBOLA

DISASTER• A total of 2,615 Ebola infections and 1,427 deaths• highest case fatality rates of any human virus, 88%

ETYMOLOGY• First recorded outbreak at,Yambuku in democratic republic of

congo (EBOLA RIVER)

VIRUS ( Latin virulentus)• Viruses do not contain enzymes for energy production or

protein synthesis.• small infectious agent that replicates only inside the living cells

of other organisms

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

3 Reasons EBOLA should never come to india

1. High rate of spread: spreads very quickly from one human to another hence extremely dangerous in a densely populated country like ours

2. Lack of healthcare services: Healthcare services in our country are abysmal to say the least. The doctor-patient ratio is skewed beyond belief

3. Lack of hygiene: as Ebola spreads by saliva,we are well aware of spitting in india

Sudan(SUDV)

Group : Group V (-)sense RNAOrder : MononegaviralesFamily : Filoviridae

Genus : Ebolavirus

Bundibugyo(BDBV)

Tai forest(TAFV)

Formerly Cote d-Ivoire

Species

Zaire ebola(EBOV)

The most dangerous

Reston(RESTV)

Non-humans

Ebola Taxonomy

STRUCTURE– Single-stranded, linear, non-segmented– Filamentous - shape of “U” or “6”– Coiled, toroid, or branched– 19 kb length,60-80 nm in diameter– Negative-sense enveloped RNA (3’ to 5’

direction)– “Spikes” appearance– 8 sub-genomic mRNA proteins: 7 structural and 1

nonstructural

Ebola Pathogenesis

• Enters Bloodstream– skin, membranes,open wounds

• Cell Level– docks with cell membrane

• Viral RNA – released into cytoplasm – production new viral proteins

• New viral genomes– rapidly coated in protein – create cores

• Viral cores–stack up in cell–migrate to the cell surface–Produce trans-membrane proteins–Push through cell surface–Become enveloped by cell membrane

• ssRNA- Genome Mutations –Capable of rapid mutation –very adaptable to evade host defenses and environmental change

ebola Attach to walls

Leakage of blood and serum into

surrounding tissue

Wbcs’ attack

Wbcs’ dissolve

Chemical released

Pro-inflammatory

cytokinesPro coagulantsAlso released

Blood vessels more

damaged

Permanent bleeding

Entire body leaks

and dissolves

Transmission

Environment to Human :

Fruit bats-natural reservoir

Gorilla, chimpanzee, monkey, porcupine, duiker

Human to human :

1. Direct contact

2. Contaminated medical equipment

3. Traditional burial rituals

4. Medical workers

5. Survivors(via semen for 2 months)

SIGNS AND SYMPTOMS 1 Early symptoms :Influenza(fatigue,fever,headache,joint & abdominal pain)Vomiting,diarrheaLoss of appetiteSore throat,chest pain,hiccups,shortness of breath, trouble swallowingWeaknessMaculopular rash(50% cases)Myalgia(muscular pain or tenderness),back painMucosal redness of the oral cavity

SIGNS AND SYMPTOMS2 Acute symptoms :Bleeding from puncture sites and mucous

membrane(eg.nose,gums and gastrointestinal tract)

Internal and subcutaneous bleedinganuria(absence of urine formation)raddening of eyes,bloody vomit Impaired blood clottingMultiple organ dysfunction syndrome which leads

to death

THE PATIENTS WILL HAVE DIARRHEA PHARYNGITIS.

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

EFFECT OF EBOLA

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 redEVD ( EBOLA VIRUS

DISEASE ) : Bleeding does not occur

EBOLA IN NON-HUMAN PRIMATES

• NON-HUMAN PRIMATES HAVE BEEN A SOURCE OF INFECTION FOR HUMANS

•  EBOLA OUTBREAKS FROM THE EBOV AND TAFV SPECIES HAVE BEEN OBSERVED IN CHIMPANZEES AND GORILLAS.

• RESTV HAS CAUSED SEVERE EVD OUTBREAKS IN MACAQUE MONKEYS (MACACA FASCICULARIS).

• RESTV VIRUSES HAVE BEEN DETECTED DURING SEVERAL OUTBREAKS OF A DEADLY DISEASE IN PIGS IN PEOPLE’S REPUBLIC OF CHINA AND PHILIPPINES.

COUNTRY YEAR

EBOLAVIRUS SPEICE

S

CASES

DEATH

CASE FATALI

TYDRC, UGANDA

2012

BUNDIBUGYO,SUDAN

88 50 56.81%

DRC, UGANDA

2007

BUNDIBUGYO,ZAIRE

413 224 54.23%

UGANDA 2000

SUDAN 425 224 53%

DRC 1995

ZAIRE 315 254 81%

COTE D`LOVIRE,GOBANA

1994

TAI FOREST,ZAIRE

53 31 58.50%

SUDAN 1979

SUDAN 34 22 65%

SUDAN, DRC

1976

ZAIRE 318 280 88%

CHRONOLOGY OF EBOLA VIRUS DISEASE OUTBREAKS

: DRC- DEMOCRATIC REPUBLIC OF CONGO

TABLE EBOLA OUTBREAKS,2014 (BY WHO)

1. DRC

2. GUINEA

3. LIBERIA

4. NIGERIA

5. SIERRA LEONE

• 24 CASES,13 DEATHS.

• 607 CASES,406 DEATHS.

• 1082 CASES,624 DEATHS.

• 16 CASES, 5 DEATHS.

• 910 CASES, 392 DEATHS.

DRC= democratic republic of congo

Anti-Fluenza:Avigan

• ZMapp (JAPAN)• combination of antibodies (inactivate ebola virus)• is effective in primates, studies in humans yet to be

done(effectively treat 43% of animals challenged with the Ebola virus)

• WHO has given an ethical green light to the use of these experimental therapies (testing on 2nd august)

• would provide a medical tool to discourage the use of Ebola virus as an agent of bioterrorism

PREVENTION OF EBOLA

Avoid contact with other infected humans,animals or objectsRaising awareness by IEC &BCCReducing human to human transmission by use of PPESafe disposal of the deadActive surveillance – Contact tracing & monitoring – Reporting /Notification

PRECAUTIONS

Use Standard PrecautionsRoutine Hand washingHandle and Dispose of Shar Instruments

SafelyCook meat thoroughlyEnvironment Cleaning

FIVE TYPES OF HAND HYGEINE

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

Gather Recommended Supplies Bed and mattress, Plastic sheeting, One thermometer,

Covered container , Screens or other barriers

Plan Disinfection for VHF-Contaminated items using1)Ordinary Household Bleach 2)Soap and Clean Water 3)Sterilization

Set Up Changing Rooms for patient-care staff

Place Security Barrier Around Isolation Area

TREATMENTNo specific treatment available but

experimental ones areFrequent dehydration and oral rehydration

with solutions containing electrolytes or intravenous fluids.

Maintaining oxygen status and blood pressureReplacing lost bloodTreating other infections if they occur

Timely treatment of ebola is difficult due to difficult diagnosis

VACCINESNo licensed vaccine for EVD is available. Several

vaccines are being tested, but none are available for clinical use.

Obtain to obtain samples and study the disease in remote areas where outbreaks occur.

A high degree of biohazard containment is required for laboratory studies and clinical analysis.

Difficulty in making vaccines

EFFECTS ON INDIA

ON TUESDAY 27 AUGUST 112 INDIAN CITIZENS AND 4 NEPALESE CITIZENS HAD LANDED FROM LIBERIA.

1 HAD FEVER SYMPTOMS AND HAD BEEN QUARANTINED.

OTHERS WERE SCREENED FOR EBOLA AND ALSO QUARANTINED.

PASSENGERS TRAVELLING FROM AFFECTED COUNTRIES WILL BE TRACKED FOR AT LEAST A MONTH (IDSP).

773 PASSENGERS ARE BEING TRACKED FOR EBOLA VIRUS.

EFFECTS ON INDIA

A TOTAL OF 44,700 INDIANS ARE LIVING IN DIFFERENT COUNTRIES HIT BY EBOLA.

A DEADLY VIRUS THAT HAS CLAIMED 932 LIVES SO FAR

300 ARE CRPF PERSONNEL DEPLOYED IN LIBERIA FOR UN PEACEKEEPING OPERATIONS.

500 INDIANS WERE IN THE REPUBLIC OF GUINEA, 3,000 IN LIBERIA AND 1,200 IN SIERRA LEONE, FROM WHERE THE MAXIMUM CASES HAVE BEEN REPORTED.

NIGERIA HAS A MUCH LARGER PRESENCE OF NEARLY 40,000 INDIAN

CITIZENS.

BIOTERRORISM NATURAL OUTBREAKS OF EBOLA HEMORRHAGIC FEVER IN AFRICA ALARMED

GLOBAL HEALTH EXPERTS.

RAISES QUESTIONS ABOUT HUMAN ACCESSIBILITY TO THE VIRUS AND HUMAN USAGES OF THE VIRUS FOR HARMFUL PURPOSES.

THEN TERRORIST GROUPS COULD USE THE RECENT OUTBREAK OF EBOLA IN AFRICA TO THEIR ADVANTAGE. BY USING THE EBOLA VIRUS AS A BIOLOGICAL WEAPON.

THIS PROSPECT IS WORTHY OF CONSIDERATION : 1.DUE TO THE HISTORY OF TERRORIST ATTACKS BY DIFFERENT GROUPS IN THE AREA. 2.THE POTENTIAL FOR THESE GROUPS TO OBTAIN EBOLA IN THE FIELD 3.THE LACK OF POLITICAL CAPACITY IN THE REGION AND GLOBAL WILL TO DEVELOP A VACCINE. 4.THE PATHOGEN’S NATURAL OCCURRENCE IN THE REGION.

ALTHOUGH DEADLY, EBOLA IS NOTORIOUSLY UNSTABLE WHEN REMOVED FROM A HUMAN OR ANIMAL HOST, MAKING WEAPONIZATION OF THE VIRUS UNLIKELY.

BIOTERRORISM

THE POSSIBILITY OF A DELIBERATE OUTBREAK IN EAST AFRICA IS A GLOBAL HEALTH AND SECURITY ISSUE

“TERRORISTS COULD HARNESS THE VIRUS AS A POWDER, LOAD IT INTO A BOMB, AND THEN EXPLODE THE BOMB IN A HIGHLY POPULATED AREA. IT COULD CAUSE A LARGE NUMBER OF HORRIFIC DEATHS.“ - PETER WALSH

"THE THING ABOUT EBOLA IS THAT IT'S NOT EASY TO WORK WITH, IT WOULD BE DIFFICULT TO WEAPONIZE.“ - DR. ROBERT LEGGIADRO

PREPARED BY:-

1. SAISHANKAR MURALI

2. ALOK KUMAR ARYA

3. MAHENDRA CHAUDARY

4. NILESH DAMA

5. AASHISH DOSHI

6. MAYUR GODAGE

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