1. Ebola Hemorrhagic FeverDeadly African VirusDr. Hythum Salah H. Mohamed NGHA -KAMC-Riyadh 6th August 2014

2. Historical Background Ebola first appeared in 1976 in 2 simultaneous outbreaks, first in Nzara which is small townin south of Sudan which infected over 284 people, with a mortality rate of 53%. After view month another out break occurred in Yambuku in Democratic Republic of Congo.The latter was in a village situated near the Ebola River, from which the disease takes itsname In Congo outbreak 318 people infected with highest mortality rate of 88% .www.who.intWWW.web.stanford.eduDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 3. Ebola Outbreaks 24 outbreaks reported by WHO from 1976 till 2012 . first outbreak occurred in Sudan( Newly south of Sudan ) and DemocraticRepublic of Congo with mortality rate of 53% and 88% respectively . Countries involved in outbreaks was , Sudan , Congo , Uganda ,Gabon , SouthAfrica ( one case in 1996 ) and Cote d'Ivoire ( one case in 1994). No case reported out of Africa till 2012 . The maximum No of infected patients was 425 in Uganda outbreak 2000 .www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 4. Ebola 2014 Outbreak August 1, 2014, the Guinea Ministry of Health announced a total of 485suspect and confirmed cases of Ebola virus disease (EVD), including 358 fatalcases. 340 cases across Guinea have been confirmed by laboratory testing to bepositive for Ebola virus infection. August 1, 2014, the Ministry of Health and Sanitation of Sierra Leone andWHO reported a cumulative total of 646 suspect and confirmed cases,including 540 laboratory confirmations and 273 reported fatal cases.www.cdc.gov update 4th August 2014Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 5. August 1, 2014, the Ministry of Health and Social Welfare of Liberia and WHOhave reported 468 suspect and confirmed EHF cases (including 129 laboratoryconfirmations) and 255 reported fatalities. August 1, 2014, the Nigerian Ministry of Health and WHO reported 4 suspectand probable cases and 1 fatal probable case. Nigerian Suspected and Confirmed Case Count are 4 .www.cdc.gov update 4th August 2014 6. Geographical Map of 2014 Outbreak 7. Genus of Ebola Virus Genus Ebolavirus is 1 of 3 members of theFiloviridae family (filovirus), along withgenus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinctspecies:1-Bundibugyo ebolavirus (BDBV)2-Zaire ebolavirus (EBOV)3-Reston ebolavirus (RESTV)4-Sudan ebolavirus (SUDV)5-Ta Forest ebolavirus (TAFV).www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6thAugust 2014 8. Bundibugyo , Zaire and Sudan Ebola virus species are associated with havewith large Ebola virus disease outbreaks in Africa . Reston ebolavirus (RESTV) and Ta Forest ebolavirus (TAFV) have notassociated with EVD in Africa . The RESTV species, found in Philippines and the Peoples Republic of China,can infect humans, but no illness or death in humans from this species hasbeen reported to date.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 9. Transmission of EVD . Ebola is introduced into the human population through close contact with theblood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infectedchimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupinesfound ill or dead or in the rainforest. Ebola spreads in the community through human-to-human transmission, withinfection resulting from direct contact (through broken skin or mucousmembranes) with the blood, secretions, organs or other bodily fluids ofinfected people, and indirect contact with environments contaminated withsuch fluids.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 10. Burial ceremonies in which mourners have direct contact with the body of thedeceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus throughtheir semen for up to 7 weeks after recovery from illness. Health-care workers have frequently been infected while treating patients withsuspected or confirmed EVD. However, the only available evidence available comes from healthy adult males.It would be premature to extrapolate the health effects of the virus to allpopulation groups, such as immuno-compromised persons, persons with underlyingmedical conditions, pregnant women and children.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 11. Natural host of Ebola virus In Africa, fruit bats, particularlyspecies of the genera Hypsignathusmonstrosus, Epomops franquetiand Myonycteris torquata, areconsidered possible natural hostsfor Ebola virus.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh6th August 2014 12. Signs and Symptoms of Ebola Haemorrhagic Fever Fever (90%-100%) Headache (40%-90%) Chills Myalgia/arthralgia (40%-80%) Malaise (75%-85%) Pharyngitis (20%-40%) Loss of appetite Vomiting (59%) Hematemesis (10%-40%) Non-bloody diarrhea (81%)http://web.stanford.edu/group/virus/filo/humandiseases.html Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 13. Blood fails to clot (71%-78%) Abdominal pain (60-80%) Dry and sore throat (63%) Chest pain (83%) Hemorrhagic diathesis (71%-78%) Maculopapular rash (5%-20%) Hiccups (15 %) Hepatic damage Renal failurehttp://web.stanford.edu/group/virus/filo/humandiseases.htmlDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 14. CNS involvement (infrequently) Terminal shock Lymphopenia Severe thrombocytopenia Transaminase elevation Hyperamylasemia During the convalescent stage:1-Loss of memory2-Central nervous system disorders3-Loss of hairhttp://web.stanford.edu/group/virus/filo/humandiseases.htmlDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 15. Diagnosis Ebola virus infections can be diagnosed definitively in a laboratory throughseveral types of tests:1-antibody-capture enzyme-linked immunosorbent assay (ELISA)2-antigen detection tests3-serum neutralization test4-reverse transcriptase polymerase chain reaction (RT-PCR) assay5-electron microscopy6-virus isolation by cell culture.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 16. Treatment No specific treatment is available . Standard treatment for Ebola HF is still limited to supportive therapy. Thisconsists of:1-balancing the patients fluids and electrolytes2-maintaining their oxygen status and blood pressure3-treating them for any complicating infections .www.cdc.govDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 17. During the 1995 Ebola Zaire outbreak in Kikwit, whole blood fromconvalescent patients was administered to eight patients late in their clinicalcourse . Only one patient died, suggesting that even small amounts oftransfused blood had a beneficial effect. However, a subsequent analysisdemonstrated that, due to good prognostic factors, these patients would havelikely survived without any intervention . convalescent serum , interferon-alpha , Ribavirin , immune globulin andplasma exchange are tried but not provided evidence of therapeutic efficacy.www.uptodate.comDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 18. Post exposure prophylaxis At this time, there are no FDA-approved forms of post exposure prophylaxisfor Ebola HF. In Animal experiments Interferon-alpha showed effectiveness . In a very promising approach to postexposure prophylaxis, an experimentallive-virus vaccine has been developed using recombinant vesicular stomatitisvirus (VSV) encoding the Marburg or Ebola surface glycoproteins. A singleinjection is completely protective as a standard preexposure vaccinewww.uptodate.comDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014 19. Infection ControlControlling infection in health-care settings it is important that health-care workersapply standard precautions consistentlywith all patients regardless of theirdiagnosis in all work practices at alltimes . These include basic hand hygiene,respiratory hygiene, the use of personalprotective equipment and safe injectionpractices and safe burial practices. When in close contact (within 1 metre) ofpatients with EBV, health-care workersshould wear face protection (a face shieldor a medical mask and goggles), a clean,non-sterile long-sleeved gown, and gloves(sterile gloves for some procedures).www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh6th August 2014 20. face shields or surgical masks and eyeprotection (e.g., goggles or eyeglasseswith side shields) should be worn bypersons coming within approximately 3feet of the patient. Patients who are hospitalized or treatedin an outpatient healthcare setting shouldbe placed in a private room and Standard,Contact, and Droplet Precautions shouldbe initiated . Nonessential staff and visitors should berestricted from entering the room ofpatients with suspected VHF.www.cdc.gov/vhf/abroad/pdf/vhf-interim-guidance.pdf-2005.Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh6th August 2014 21. Laboratory workers are also atrisk. Samples taken from suspectedhuman and animal Ebola cases fordiagnosis should be handled bytrained staff and processed insuitably equipped laboratories.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh6th August 2014 22. Reducing the risk of Ebola infection in people raising awareness of the risk factors forEbola infection and the protectivemeasures individuals can take is the onlyway to reduce human infection and death. Reducing the risk of wildlife-to-humantransmission from contact with infectedfruit bats or monkeys/apes and theconsumption of their raw meat handled with gloves and otherappropriate protective clothing. Animalproducts (blood and meat) should bethoroughly cooked before consumption.www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6thAugust 2014 23. Reducing the risk of human-to-humantransmission in thecommunity arising from direct orclose contact with infectedpatients, particularly with theirbodily fluids. Close physicalcontact with Ebola patients shouldbe avoided. Gloves and appropriate personalprotective equipment should beworn when taking care of illpatients at home and burial of thedead .www.who.intDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh6th August 2014 24. Ebola ReportedOutside Africa Ebola in Saudi Arabia Ebola in Saudi Arabia Ebola in Saudi Arabia Ebola in Saudi Arabia Ebola in Saudi Arabia Ebola in Saudi Arabia Ebola in Saudi Arabia Ebola in Saudi ArabiaEbola in Saudi ArabiaDr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh6th August 2014 25. Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014