Matthew Rollosson, RN, MPH&TM 6 October 2014

Arenaviridae ◦ Argentine, Bolivian, Brazilian, Chapare, Venezuelan

hemorrhagic fevers ◦ Lassa fever

Bunyaviridae ◦ Crimean-Congo hemorrhagic fever ◦ Hantaviruses ◦ Rift Valley Fever

Filoviridae ◦ Ebola ◦ Marburg

Flaviviridae ◦ Dengue ◦ Yellow fever

Filo: thread ◦ Three genera:

Ebolavirus

Cuevavirus (Spain)

Marburgvirus (Germany)

◦ Ebola

Five species

Bunbidugyo (Uganda)

Reston (Virginia, U.S.)

Sudan

Taï Forest (Côte d’Ivoire)

Zaïre (Congo)

CDC/Frederick A. Murphy

CDC/NIAID

1968, Germany and Yugoslavia ◦ Laboratory workers exposed to blood and tissue of

African green monkeys from Uganda

Secondary transmission to family and other health care workers

◦ 31 people infected

7 deaths (case fatality 23%)

◦ Sporadic outbreaks in Africa

Case fatality as high as 90%

1989, Reston, Virginia, U.S. ◦ Cynomolgus macaques imported from the

Philippines

◦ Highly lethal to primates

Also infects pigs

◦ Not pathogenic to humans

Lab workers showed serological evidence of infection, but did not become ill

1976, Yambuku, Zaïre (now the Democratic Republic of the Congo) ◦ Near the Ebola River

Occurred at the same time as first identified outbreak of Sudan ebolavirus

◦ Species that causes most Ebola outbreaks

Current outbreak in West Africa

Fruit bats are most likely the natural reservoir for the virus ◦ Outbreaks frequently associated with mining

Infects monkeys and apes ◦ Large die-offs of chimpanzees and gorillas ◦ Taï Forest ebolavirus

One human infection Acquired during autopsy of a chimpanzee

Outbreaks may be associated with hunting or butchering animals or eating infected meat ◦ Bat soup ◦ Bushmeat

Direct contact with blood or body fluids of a symptomatic person ◦ Skin

Cuts, abrasion

◦ Mucous membranes

◦ Parenteral

Reusing unsterilized needles

◦ Funeral ceremonies

Respiratory droplets? ◦ Not airborne

Not effectively transmitted by fomites

Incubation period ◦ 2 to 21 days

Mean 4 to 10 days

◦ Not infectious until symptom onset

Sudden onset ◦ Fever

◦ Muscle pain

◦ Fatigue

◦ May be a transient maculopapular rash

Vomiting, diarrhea

Liver failure

Abdominal pain

Bleeding disorders ◦ Gastrointestinal bleeding

◦ Bleeding from venipuncture sites

◦ Mucous membranes

Renal failure

Neurological symptoms

Death or recovery ◦ 7 to 14 days after symptom onset

◦ Prolonged convalescence

◦ Immunity

Convalescent serum as treatment?

◦ Virus may be present in semen up to 7 weeks after recovery

Rehydration and supportive care improve survival

March 22 ◦ First cases reported

◦ Guinea: 49 people

August 31 ◦ 3,685 cases

September 23 ◦ 6,574 cases

Liberia: 3,458 cases

Sierra Leone: 2,021 cases CDC, 2014c

CDC, 2014c

Liberia ◦ Doubling every 15-

20 days

Sierra Leone ◦ Doubling every 30-

40 days

CDC estimates that cases may be underreported by a factor of 2.5

Cumulative number of Ebola virus disease cases reported – five countries, West Africa, March 29 – September 20, 2014

CDC, 2014d

July 20 ◦ Ill patient travels from Liberia to Lagos, Nigeria

Nigeria

Most populous country in Africa

Lagos

Most populous city in Africa

Air, ground, and sea transit hub

July 23 ◦ Ebola Incident Management Center (EOC) activated

CDC, 2014b

Contact tracing ◦ 894 contacts identified

◦ 18,500 face-to-face visits conducted

Isolation of suspected cases ◦ No transmission within isolation wards

Hospitalization of confirmed cases

Coordination of donors, partner organizations, and response teams

19 laboratory-confirmed cases, 1 probable ◦ 8 deaths (40%)

No new cases since August 31

CDC, 2014b

September 20 ◦ Passenger arrives in Dallas from Liberia

September 24 ◦ Patient became ill

September 26 ◦ Patient seen at hospital

◦ Discharged

September 28 ◦ Patient admitted with symptoms consistent with

EVD

October 2 ◦ Court-ordered home isolation of contacts

CDC does not recommend quarantining asymptomatic contacts of Ebola cases

October 3 ◦ 50 contacts identified

10 with high risk exposures

Daily fever monitoring

October 20 ◦ ?

According to the CDC, ◦ Any U.S. hospital that is following CDC’s infection

control recommendations and can isolate a patient in their own room‎ with a private bathroom is capable of safely managing a patient with Ebola

◦ Health care professionals in the U.S should immediately report to their state or local health department any person being evaluated for EVD if the medical evaluation suggests that diagnostic testing may be indicated

◦ CDC is NOT recommending that asymptomatic contacts of EVD patients be quarantined, either in facilities or at home

CDC has consulted state and local health departments on over 100 people with travel history and symptoms that suggested EVD

◦ 14 considered to be truly at risk

13 tested for Ebola

All were negative

Doctors Without Borders ◦ www.doctorswithoutborders.org

International Medical Corps ◦ https://internationalmedicalcorps.org

Partners in Health ◦ www.pih.org

USAID ◦ www.usaid.gov/ebola/volunteers

Bausch, D. G., Towner, J. S., Dowell, S. F., Kaducu, F., Lukwiya, M., Sanchez, A., et al. (2007). Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. Journal of Infectious Diseases, 196(Supple. 2), S142-S147.

Blumberg, L., Enria, D., & Bausch, D. G. (2014). Viral hemorrhagic fevers.

In J. Farrar, P. J. Hotez, T. Junghanss, G. Kang, D. Lalloo, & N. J. White (Eds.) Manson's tropical diseases, 23rd Ed. [Electronic version]. Elsevier.

Centers for Disease Control and Prevention. (2014). CDC and Texas

Health Department confirms first Ebola case diagnosed in the U.S. http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-case.html.

Centers for Disease Control and Prevention. (2014). Ebola virus disease

outbreak – Nigeria, July-September, 2014. Morbidity and Mortality Weekly Report, 63(39), 867-872. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm.

Centers for Disease Control and Prevention. (2014). Ebola virus disease outbreak – West Africa, September, 2014. Morbidity and Mortality Weekly Report, 63(39), 865-866. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a4.htm.

Centers for Disease Control and Prevention. (2014). Estimating the

future number of cases in the Ebola epidemic – Liberia and Sierra Leone, 2014-2015. Morbidity and Mortality Weekly Report, 63(3), 1-14. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm.

Centers for Disease Control and Prevention. (2014). Interim guidance for

monitoring and movement of persons with Ebola virus disease exposure. http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html.

Centers for Disease Control and Prevention. (2014). Questions and

answers on Ebola. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html.

Center for Infectious Disease Research and Policy. (2014). Texas contact tracing identifies 50 for Ebola fever monitoring. http://www.cidrap.umn.edu/news-perspective/2014/10/texas-contact-tracing-identifies-50-ebola-fever-monitoring.

Center for Infectious Disease Research and Policy. (2014). Texas issues

Ebola home isolation court order. http://www.cidrap.umn.edu/news-perspective/2014/10/texas-issues-ebola-home-isolation-court-order.

Frieden, T. (2014). Why U.S. can stop Ebola in its tracks.

http://www.cnn.com/2014/10/02/opinion/frieden-ebola-first-patient/index.html.

Geisbert, T. W. (2014). Marburg and Ebola hemorrhagic fevers

(Filoviruses). In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds.). Mandell, Douglas, and Bennett's principles and practice of infectious diseases, 8th Ed. [Electronic version]. Elsevier.

Hartman, A. L. (2013). Ebola and Marburg virus infections. In, A. J. Magill, D. R. Hill, T. Solomon, & E. T. Ryan (Eds.) Hunter's tropical medicine, 9th Ed. [Electronic version]. Elsevier.

World Health Organization. (2014). Ebola virus disease. Retrieved 1 October 2014 from http://www.who.int/mediacentre/factsheets/fs103/en.

Tanzania, August 2014