Ebola virus disease (2)

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Ebola Scare

OUTLINEIntroductionHistoryCurrent outbreakCausative agentTransmissionClinical presentation of EVDDiagnosisManagementEfforts of Government in containing the diseaseCommon myths on EbolaINTRODUCTIONEbola virus disease (EVD) was formerly known as Ebola haemorrhagic fever. It is a severe and often fatal illness in humans.

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

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

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

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

HISTORYThe 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 ContdThe 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 NSeka: 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 OUTBREAKSYearCountry of occurrenceEV speciesRecorded casesDeaths1976DRCZaire3182801976SudanSudan2841511977DRCZaire111979SudanSudan34221989USAReston401994GabonZaire52311994Cote de IvoireTai Forest101995DRCZaire3152541996(Jan-April)GabonZaire31 211996(Jul-Dec)GabonZaire60451996South AfricaZaire112000UgandaSudan4252242001-2002Gabon Zaire6553CHRONOLOGY OF PREVIOUS EBOLA VIRUS DISEASE OUTBREAKS ContdYearCountry of occurrenceEV speciesRecorded casesDeaths2001-2002CongoZaire59442003(Jan-April)CongoZaire1431282003(Nov-Dec)CongoZaire35292004SudanSudan1772005CongoZaire12102007DR CongoZaire2641872007UgandaBundibugyo149372008DR CongoZaire32142011UgandaSudan112012UgandaSudan24172012UgandaSudan742012DR CongoBundibugyo572CURRENT OUTBREAKCurrent epidemic ravaging West African countries is the largest and most severe Ebola outbreak to occur since the virus was first identified 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) declared the outbreak a Public Health Emergency of International Concern.

Public Health Emergency of International Concern is a designation that invokes obligatory legal measures on disease prevention, surveillance, control and response by 194 signatory countries of WHO.

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


West African Countries Ravaged By EVD

Cumulative totals of cases and deaths over time

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

So far, Nigeria has recorded 14 confirmed cases (12 primary and 2 secondary contacts) including 5 deaths, five fully recovered and four others still 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 treated Sawyer travelled before falling sick.

Mainland Hospital, Yaba - an infectious diseases hospital owned by the Lagos State Government is being used for isolation and treatment of confirmed cases.

Patrick SawyerDr Stella Adedevoh

Dr Stella AdedevohCAUSATIVE AGENTEVD is caused by Ebola virus.

It is an RNA virus of the Filoviridae family: the family of filamentous viruses.

There are 5 species of Ebola virus named after their original site of outbreak:Zaire Ebola virusSudan Ebola virusBundibugyo Ebola virusTai Forest Ebola virusReston Ebola virus

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

Ebola virusTRANSMISSIONTransmission: This is by direct contact from:Animal to human.

Human to human.

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

Fruit bats

Primates: monkeys, apes, gorillas, etc.

Forest antelopes






Non-human primate Forest Antelope

Forest AntelopePorcupine

PorcupineTRANSMISSION ContdHuman to human: Transmission is by direct contact with body fluids of infected cases or corpses of those that have died of the disease. The virus can be found in any of the following body fluids:Sweat Blood Saliva Break milk Urine Semen TearsPeople 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 feverHeadacheJoint and muscle painsTirednessNauseaRashesSore throat CoughChest pains

Typical papular rashClinical presentation of EVD ContdLate 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 skinEFFECT OF EBOLA VIRUS ON THE BODYThe 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 DiagnosisGeneral lab findings include:

Low white blood cell and platelet count.

Low red blood cell count.

Deranged electrolytes.


Elevated liver enzymes.

Low clotting profile.Confirmatory testConfirmatory test can be done in an appropriately equipped laboratory using a multitude of approaches including:

ELISA based techniques to detect anti-Ebola antibodies or viral antigens.

RT-PCR to detect viral RNA.

Immunoelectron microscopy to detect Ebola virus particles in tissues and cells.

Indirect immunofluorescence to detect antiviral antibodies. Accredited laboratories for evs in NigeriaFour laboratories that specialize in testing of the Ebola virus were named 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 sited in Jos, Kano and Enugu. At least 9 laboratories are to be sited across the country before the end September, 2014.

Laboratory scientist in BSL4 Laboratory





Lassa fever


Dengue feverManagementThere are currently no vaccines or drugs of proven efficacy for EVD. The management goals are therefore to:Prevent further spread to uninfected persons. 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:

Isolation and barrier-nursing of all infected cases.

Quarantine of all contacts of infected persons.

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

Wearing of standard containment gears by health workers attending to infected persons and corpses.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 RegularlyWash your hands Regularly

Wash your hands RegularlyQueen 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 contdTreatment of infected persons: There is currently no proven effective antiviral drug in the market. The aim of treatment is to preserve the patients 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 DrugsThe 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 thetreatment 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 ContdGarcinia 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 vaccinesThe WHO has said that clinical trials of a vaccine for the Ebola virus may begin in September 2014 and be made available by 2015.

WHOs 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 Bishops Conference of Nigeria suspends exchange of sign of peace and reception of holy communion with the tongue

Governments Efforts In Containing the EpidemicDeclared 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 $100million in aid to help contain the disease across West Africa.Onyebuchi Chukwu-Minister of Health

Onyebuchi Chukwu-Minister of HealthMargaret Chan- World Health Organization Director General

Margaret Chan-World Health Organization Director GeneralCommon Myths about EbolaEbola 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 by enemies

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 SolutionKidnap victims plight

RECAPEbola 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 persons including corpses.

Symptoms include fever, headache, diarrhea, vomiting, weakness, joints and muscle pains, chest pain, cough, skin rashes, bleeding from all openings in the body.

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