PUBLIC ENLIGHTENMENT

ON

EBOLA VIRUS DISEASE

EBOLA SCARE

OUTLINE

Introduction

History

Current outbreak

Causative agent

Transmission

Clinical presentation of EVD

Diagnosis

Management

Efforts of Government in containing the disease

Common myths on Ebola

INTRODUCTION Ebola virus disease (EVD) was formerly known as Ebola

haemorrhagic fever. It is a severe and often fatal illness inhumans.

About 90% of people that are infected with Ebola virus will diefrom it. It is one of the deadliest diseases in the world killing infew weeks.

Ebola virus is classified as a biosafety level 4 agent, as well asa Category A bioterrorism agent by the Centers for DiseaseControl and Prevention.

EVD is a zoonotic infection meaning that it a disease of animalswhich is transmissible to man under natural conditions.

There have been several recorded outbreaks of EVD in someAfrican countries prior to the current epidemic in West Africa.

HISTORY

The first outbreak of EVD was in 1976 in Yambuku, Zaire (now

Democratic Republic of Congo).

The outbreak recorded 318 cases and 280 deaths giving a case

fatality rate of about 88%.

Most of the deaths were among patients who were given

injections with contaminated needles.

At about the same time in 1976, another outbreak occurred in

Maridi, Sudan (present day South Sudan) that recorded 284

cases and 151 deaths with fatality rate of over 53%.

HISTORY CONTD The name Ebola originated from Ebola River around which

Yambuku, where the first outbreak that occurred was located.

Ngoy Mushola -a Congolese medical doctor was the first

person to record a description of the Ebola virus in 1976.

The first patient to be diagnosed of EVD was Mayinga

N’Seka: a nurse in Zaire in 1976.

Since after the 1976 outbreaks in Zaire and Sudan, there have

been several epidemics of the disease in other parts of Africa.

CHRONOLOGY OF PREVIOUS EBOLA VIRUS

DISEASE OUTBREAKS

Year Country of

occurrence

EV species Recorded

cases

Deaths

1976 DRC Zaire 318 280

1976 Sudan Sudan 284 151

1977 DRC Zaire 1 1

1979 Sudan Sudan 34 22

1989 USA Reston 4 0

1994 Gabon Zaire 52 31

1994 Cote de’ Ivoire Tai Forest 1 0

1995 DRC Zaire 315 254

1996(Jan-April) Gabon Zaire 31 21

1996(Jul-Dec) Gabon Zaire 60 45

1996 South Africa Zaire 1 1

2000 Uganda Sudan 425 224

2001-2002 Gabon Zaire 65 53

CHRONOLOGY OF PREVIOUS EBOLA VIRUS

DISEASE OUTBREAKS CONTD

Year Country of

occurrence

EV species Recorded

cases

Deaths

2001-2002 Congo Zaire 59 44

2003(Jan-April) Congo Zaire 143 128

2003(Nov-Dec) Congo Zaire 35 29

2004 Sudan Sudan 17 7

2005 Congo Zaire 12 10

2007 DR Congo Zaire 264 187

2007 Uganda Bundibugyo 149 37

2008 DR Congo Zaire 32 14

2011 Uganda Sudan 1 1

2012 Uganda Sudan 24 17

2012 Uganda Sudan 7 4

2012 DR Congo Bundibugyo 57 2

CURRENT OUTBREAK Current epidemic ravaging West African countries is the largest and

most severe Ebola outbreak to occur since the virus was firstidentified in 1976, in terms of cases and deaths.

It began in Guinea in March 2014 and has since spread to Liberia,Sierra Leone, Nigeria and now DRC.

On 8 August 2014, the World Health Organization (WHO) declaredthe outbreak a Public Health Emergency of International Concern.

Public Health Emergency of International Concern is adesignation that invokes obligatory legal measures on diseaseprevention, surveillance, control and response by 194 signatorycountries of WHO.

As at 20th August, 2014, a total of 2615 suspected cases with 1427deaths have been reported by WHO, of which 1528 cases and 844deaths have been confirmed to be EVD.

WEST AFRICA

WEST AFRICAN COUNTRIES RAVAGED BY EVD

CUMULATIVE TOTALS OF CASES AND DEATHS OVER TIME

CURRENT OUTBREAK CONTD

The first case in Nigeria was reported by the WHO on 25th July, 2014:Patrick Sawyer- a Liberian Ministry of Finance official, that flew from Liberiato Nigeria after exposure to the virus and died in a Lagos hospital soon afterarrival. This is the first case of Ebola disease to be internationally exportedthrough air travel.

So far, Nigeria has recorded 14 confirmed cases (12 primary and 2secondary contacts) including 5 deaths, five fully recovered and four othersstill in treatment centre.

The deaths were the index case, the most senior doctor(female consultant physician) who participated in the management of the index case, 2 health workers and an ECOWAS protocol staff that welcomed Patrick Sawyer at the airport.

About 213 primary and secondary contacts are currently under surveillance.6 out of the 213 are under watch in Enugu where a nurse who had treatedSawyer travelled before falling sick.

Mainland Hospital, Yaba - an infectious diseases hospital owned by theLagos State Government is being used for isolation and treatment ofconfirmed cases.

Patrick Sawyer

DR STELLA ADEDEVOH

Dr Stella Adedevoh

CAUSATIVE AGENT EVD is caused by Ebola virus.

It is an RNA virus of the Filoviridae family: the family of filamentousviruses.

There are 5 species of Ebola virus named after their original site ofoutbreak:

1. Zaire Ebola virus

2. Sudan Ebola virus

3. Bundibugyo Ebola virus

4. Tai Forest Ebola virus

5. Reston Ebola virus

Zaire Ebola virus is the most virulent strain and it is implicated inthe current epidemic.

Ebola virus

TRANSMISSION

Transmission: This is by direct contact from:

1. Animal to human.

2. Human to human.

Animal to human: Transmission from animals to humans is probably from:

Fruit bats

Primates: monkeys, apes, gorillas, etc.

Forest antelopes

Porcupines

Pigs

TRANSMISSION

TRANSMISSION

Transmission

BATSBats

Non-human primate

FOREST ANTELOPE

Forest Antelope

PORCUPINEPorcupine

TRANSMISSION CONTD2. Human to human: Transmission is by direct contact with body

fluids of infected cases or corpses of those that have died of the

disease.

o The virus can be found in any of the following body fluids:

o Sweat

o Blood

o Saliva

o Break milk

o Urine

o Semen

o Tears

People are not contagious until they develop symptoms.

Family members and health workers are most affected.

Spread through air has not been confirmed.

CLINICAL PRESENTATION OF EVDIncubation period: 2-21 days.

Clinical symptoms: These are divided into early and late symptoms.

Early symptoms: Non-specific and usually appear between 2-10 days after exposure. They include:

High grade fever

Headache

Joint and muscle pains

Tiredness

Nausea

Rashes

Sore throat

Cough

Chest pains

Typical papular rash

CLINICAL PRESENTATION OF EVD CONTD

Late Symptoms: May appear from 11-21 days of exposure.

Bleeding from the eyes, nose, ears, mouth, anus, etc.

Vomiting that may contain blood.

Diarrhoea which may last for 10 days that may contain blood.

Cough with bloody sputum.

Swelling and redness of the eyes.

Bleeding into the skin.

Enlargement of the liver.

Testicular Swelling with pain.

Bleeding into the skin

Bleeding into the skin

EFFECT OF EBOLA VIRUS ON THE BODY

The sequence of events on the body are:

Contact with infected body fluids that contain the virus.

Replication of the virus in the tissues of the infected person.

Circulation of the virus in the blood in large numbers.

Dissemination of the virus into major organs and tissues.

Reduction in number of all blood cells including platelets that are

responsible for blood clotting.

Severe bleeding from all possible external openings including skin

and internal organs and tissues.

Increased blood vessel permeability causing blood to ooze out of

the vessels into surrounding tissues and organs.

Decreased circulating blood volume causing shock.

Clotting disorder.

Swelling of internal organs and tissues including the brain.

Death from shock, clotting disorder, and brain swelling.

DIAGNOSISIs made by:

High index of suspicion.

History of sudden onset of severe febrile illness not

responding to treatment for common ailments.

History of recent travel to countries ravaged by the epidemic.

History of contact with wild life

Recent contact with an infected person: living or dead.

LABORATORY DIAGNOSIS

General lab findings include:

Low white blood cell and platelet count.

Low red blood cell count.

Deranged electrolytes.

Proteinuria.

Elevated liver enzymes.

Low clotting profile.

CONFIRMATORY TEST

Confirmatory test can be done in an appropriately equippedlaboratory using a multitude of approaches including:

ELISA based techniques to detect anti-Ebola antibodies orviral antigens.

RT-PCR to detect viral RNA.

Immunoelectron microscopy to detect Ebola virus particlesin tissues and cells.

Indirect immunofluorescence to detect antiviral antibodies.

ACCREDITED LABORATORIES FOR EVS IN NIGERIA

Four laboratories that specialize in testing of the Ebola virus werenamed by the Federal Government. These are:

Centre for Disease Control in Asokoro, Abuja.

Lagos University Teaching Hospital.

University College Hospital, Ibadan.

Redeemers University Laboratory, Lagos.

Irrua Specialist Teaching Hospital Edo State

More laboratories and mobile test centers are planned to be sitedin Jos, Kano and Enugu. At least 9 laboratories are to be sitedacross the country before the end September, 2014.

LABORATORY SCIENTIST IN BSL4 LABORATORY

OTHER DISEASES WITH SIMILAR FEATURES

Malaria

Typhoid

Cholera

Dysentery

Lassa fever

Marburg

Dengue fever

MANAGEMENTThere are currently no vaccines or drugs of proven efficacy for EVD. The management

goals are therefore to:

1. Prevent further spread to uninfected persons.

2. Treatment of infected persons through supportive care and use of experimental

drugs where available and approved.

Prevention in the health care settings:

In health facilities and clinical settings, this is achieved by:

a. Isolation and barrier-nursing of all infected cases.

b. Quarantine of all contacts of infected persons.

c. Strict observance of universal precautions by health workers in clinical settings.

d. Wearing of standard containment gears by health workers attending to infected

persons and corpses.

e. Decontamination and disinfection of all materials that have had contact with

infected cases and their secretions.

ISOLATION CENTRE

HEALTH WORKERS KITTED FOR WORK

MANAGEMENT CONTDPrevention in the community:

Avoid contact with infected individuals.

Minimize stay in crowded places like churches, mosques, political rallies,

crusades, markets, etc.

Regular hand washing with soap, and use of hand sanitizers where

possible.

Cover mouth with handkerchief when sneezing or coughing.

Hygienic disposal of all human and animal wastes.

Infected corpses should be cremated or disposed aseptically in

designated place.

MANAGEMENT CONTDPrevention in the community:

Seek medical care for all cases of febrile illness.

Regular clearing and disinfection of animal farms.

Cull infected animals.

Animal products should be thoroughly cooked before consumption.

Avoid eating bats and bush meat particularly monkeys, apes etc.

Avoid eating fruits that has been bitten by bats.

Report every suspected case to a health facility or through Ebola toll free

numbers: 08023169485,08033086660,0800EBOLAHELP

Wash your hands Regularly

WASH YOUR HANDS REGULARLY

Wash your hands Regularly

QUEEN ELIZABETH TRADITIONALLY WEARS

HAND GLOVES FOR OCCASION

HEALTH WORKERS EVACUATING CORPSE

FROM HOSPITAL.

CORPSE BEING TAKEN FOR BURIAL

SMOKED ROAD SIDE BUSH MEAT

ALTERNATIVES TO BUSH MEAT

MANAGEMENT CONTD

Treatment of infected persons: There is currently no proven effective

antiviral drug in the market. The aim of treatment is to preserve the

patient’s life through supportive care.

Treatment is therefore directed at:

Relief of symptoms.

Maintaining renal function.

Maintenance of electrolyte and fluid balance.

Combating haemorrhage and shock.

EXPERIMENTAL DRUGS

The WHO has approved the use of experimental drugs for the

treatment of this deadly virus.

Zmapp: A drug yet to undergo human clinical trial before the

onset of the current epidemic but is being used for the 2 infected

Americans.

TKM Ebola- an experimental drug approved for use by FDA

Nanosilver: An experimental drug developed by a Nigerian in

diaspora for the treatment of Ebola.

Nanosilver however, failed to meet the requirements of the

National Health Research Ethics Code for use in Nigeria.

AMERICAN SURVIVORS OF EVD

EXPERIMENTAL DRUGS CONTD

Garcinia kola (bitter kola): Preliminary study of the plant

in the 1990s showed signs that it may benefit Ebola victims

by slowing down multiplication of the virus.

Yet to undergo animal and human trials thus not

scientifically proven as remedy for EVD.

Garcinia kola(bitter kola)

HOPE FOR VACCINES

The WHO has said that clinical trials of a vaccine for the

Ebola virus may begin in September 2014 and be made

available by 2015.

WHO’s head of vaccines and immunization, Jean-Marie

Okwo Bele stated that September 2014 is being targeted

for the start of clinical trials, first in the United States and

later in African countries where we currently have the

cases.

PROTECTIVE GEAR

CATHOLIC BISHOP’S CONFERENCE OF NIGERIA SUSPENDS EXCHANGE OF SIGN OF PEACE

AND RECEPTION OF HOLY COMMUNION WITH THE TONGUE

GOVERNMENT’S EFFORTS IN CONTAINING THE EPIDEMIC

Declared EVD national health emergency with all ports of

entry into the country on Red Alert.

Set up committee on EVD.

Earmarked 1.9billion naira for EV related activities.

Included EV screening certificates as precondition for

travelling in and out of the country.

Banned interstate transfer of corpse without dead certificate.

Set up official Ebola information website on

Ebola(www.ebolaalert.org) and toll free number:

0800EBOLAHELP.

On 31st July, 2014 the WHO and West Africa nations

announced $100 million in aid to help contain the disease

across West Africa.

ONYEBUCHI CHUKWU-MINISTER OF

HEALTHOnyebuchi Chukwu-Minister of Health

MARGARET CHAN- WORLD HEALTH

ORGANIZATION DIRECTOR GENERALMargaret Chan-World

Health Organization

Director General

COMMON MYTHS ABOUT EBOLA

Ebola virus was sent by Boko Haram.

EV was sent by the West to depopulate Africa.

EV is a sign of end time or punishment from God or was sent byenemies

EV does not exist.

EVD can be prevented by drinking salt water and bathing with same.

I cannot get EVD because it is not my portion; then whose portion?

EVD can be cured by laying of hands and attending night vigils.

Sleeping with virgins can cure EVD.

SALT SOLUTION

Salt Solution

KIDNAP VICTIM’S PLIGHT

RECAP Ebola is a very scary viral disease that kill most of its victims with no

proven cure or vaccine yet.

It is contracted through direct contact with body fluids of infected personsincluding corpses.

Symptoms include fever, headache, diarrhea, vomiting, weakness, jointsand muscle pains, chest pain, cough, skin rashes, bleeding from allopenings in the body.

Protect yourself by washing your hands with soap and water, disinfect andfumigate your surroundings

Use protective gear if you must care for a sick person.

Report suspicious symptoms in yourself or anyone else to hospital.

Avoid bush meat for now and educate every one.

FINALLYEbola disease is an extraordinary outbreak that

requires extraordinary measures.

Together (armed with the right information) we can

defeat it.

All hands must be on deck!

MERCI BEAUCOUP