PRESENTED BY: SHABIR AHMAD GANAI M.V.SC STUDENT

DIVISION OF VETERINARY PUBLIC HEALTH & EPIDEMIOLOGY

WELCOME

MAJOR ADVISOR: Dr. Ziaul Hassan Munshi

Credit Seminar

EBOLA VIRAL DISEASE- An Emerging Zoonosis

Etymology

• The name Ebola is after a river in the Yambuka village in Zaire where the first outbreak took place in 1976.

• The outbreak started with an index case on 1stSep 1976 having Malaria like symptoms which was later identified as Ebola viral Disease

(WHO,2014)

EBOLA VIRAL DISEASE Acute serious illness often fatal if untreated, initially

manifests as fever, chills and Myalgia.Haemorrhages set in afterwards which manifests as

petechia, echymoses and subsequently internal bleeding involving multiple organs.

(WHO,2014)

ETIOLOGY

Family: Filoviridae . Genus: Ebola. Genome: single stranded, (-ve) sense, non segmented ‑

RNA molecule.Encodes seven genes: Nucleoprotein (NP), virion

protein 35 (VP-35), VP40, Glycoprotein (GP), VP30, VP24, RNA dependent RNA polymerase (L). ‑

(IJMM, 2014)

Structure of Virion

Strains:

1: Zaire Ebola Virus. 2: Sudan Ebola Virus. 3: Reston Ebola Virus. 4:Tai Forest Ebola virus. 5: Bundibugyo Ebola Virus. (WHO,2014)

TRANSMISSION

Fruit bats of Family Pteropodidae are natural Ebola virus host.

Introduced into human population through close contact with the blood, secretions, organs or other body fluids of infected animals such as chimpanzees, gorrilas, duikers ,monkeys etc .

Human-to-human transmission: - Direct contact (through broken skin or mucus membranes) with

the blood, secretions, organs or other body fluids of infected people and with surfaces and materials (bedding, clothing) contaminated fluids.

(IJMM,2014)

Epidemic Timeline of 2014 outbreakDec.2.2013, 2 yr old boy Emile in Guinea became the index case of the current EVD epidemic. He died in village Meliandou , his mother, sister and grandmother then became ill with similar symptoms and also died.

2014 West African epidemic• As of November 14th 2014

• Total cases : 14413

• Total Deaths: 5506

(CDC,2014)

•

List of important Ebola outbreaks

– Total outbreaks since 1976= 27 – Total Deaths= 7706

(CDC.2014)

Country year cases Deaths

SUDAN 1976 284 151

ZAIRE 1976 318 280GABON 1994 52 31ZAIRE 1995 315 254

UGANDA 2000 425 224DRC 2007 264 187

UGANDA 2012 24 17

INDIA &EVD

• On 10.Nov.26yr old indian returned treated from Liberia was found positive for Ebola virus in his Semen ,was thus quarantined in Special Health Facility at Delhi Airport.

(Reuters,18.11.14)

PATHOGENESIS

• The virus gains entry into the body through mucosa, skin abrasion or directly through blood. Monocyte, macrophage and dendritic cells, hepatocyte, adrenal cortical cells and endothelial cells are the target cells.

• The initial replication occurs in monocytes, macrophage and dendritic cells and via these cells dissemination of virus occurs to lymph nodes, spleen, liver and other organs.

(IJMM,2014)

Incubation period: 2 to 21 days

Symptoms

• Onset of fever.• Intense weakness.• Muscle Pain.• Headache.• Sore Throat.• Vomition, Diarrhoea.• Impaired Kidney and liver function.

As it progresses:

Severe vomitingAbdominal painDiarrheaHaemorhages PharyngitisConjunctivitisExternal bleedingExtremely high body temperatureProstration

Diagnosis and identification

Clinical Diagnosis:

• Difficult to distinguish from other infectious diseases such as Malaria,Typhoid fever,Meningitis etc.

• Confirmation is made using various tests :• CBC (low WBC count, low platlet count)• Antibody capture ELISA. • Antigen capture ELISA• Serum Neutralization test.• Electron Microscopy• Virus Culturing in cell lines

(WHO,2014)

Diagnosis Continued…

• Reverse Transcriptase PCR

(WHO,2014)

Treatment and vaccines

• There is as yet no proven treatment available for EVD.

• However following certain basic interventions when used early can significantly improve the survivalchances: 1. Providing intravenous fluids (I/V) for maintaining electrolyte balance and preventing dehydration.

2. Maintaining oxygen status and blood pressure.3. Treating other infections if they occur.

.

Investigational products• There are experimental Ebola vaccines and drugs

under trial, these products are in the earliest stages and have not been fully tested for safety or effectiveness. Some of the important products which are undergoing clinical trials for the treatment of EVD are:

• Zmapp: A biopharmaceutical drug comprising three chimeric Monoclonal Antibodies.

• TKM-Ebola: RNA Interference Drug.• Favipiravir : Inhibitor of RNA dependent RNA

polymerase

Experimental Vaccines

• ChAd3: Recombinant vaccine using chimpanzee Adenovirus as vector.

• Vsv-ebov: Recombinant vaccine using vesicular stomatitis virus.

(NIH,2014)

Control and Prevention

Good outbreak control relies on applying a package of interventions viz:.

• Contact tracing.• Safe burials.• Cordon sanitare• Public awareness. (WHO,2014)

Control &preven....

1. Wildlife to Human transmission:• Handling of infective animals using appropriate protection

equipments.• Thorough cooking of bush meat before consumption.

2. Human to Human transmission: • Personal protection equipments while taking care of infective cases.• Regular hand washing after patient attendance.

(WHO,2014)

Personal protection equipments

Conclusion• The terrifying statistics revealed during the recent

EVD outbreak can repeat anywhere, anytime if appropriate measures are not put in place.

• The Scientists, Doctors, Drug manufacturers (all sister concerns) and public has to work in unison if we want the wrath of 2014 not to happen again in future.

• The call to Action is not tomorrow nor next week but Right now.

FOR PATIENT HEARING; HAVE A BRILLIANT LIFE AHEAD.