Ebola Virus Outbreak

8/9/2019 Ebola Virus Outbreak

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Ebola Virus Outbreak

Atar Derj


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Table of Contents

List of Acronyms:............................................................................3

Abstract:.....................................................................................4

Introduction:.................................................................................51. Basic information about Ebola virus:..................................................5

. Ebola virus disease:.....................................................................6

!. Occurrence and e"idemiolo#y:.........................................................7

$. Ty"es of transmissions:.................................................................8

%. &ia#nosis:..............................................................................10

'. (ublic )ealt* care issues+ "revention and control:..................................11

,. Outbreak nuisances and *istory:.....................................................12

Conclusion:................................................................................16

-eferences:.................................................................................17

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List of Acronyms:

EVD : Ebola Virus Disease

WHO: World Health Organization

EBOV: Zaïre ebola virus

BDBV: Bundibuygyo ebola virus

SDV: Sudan ebola virus

!A"V: !aï "orest ebola virus

#ES!V: #eston ebolavirus

$OH: $inistry o% Health

E&'SA: enzy(e)lin*ed i((unosorbent assay

#!)+,#: #everse trans-ri.tase .oly(erase -hain rea-tion

EO,: E(ergen-y O.erations ,enter

+HA,: +ubli- Health Agen-y o% ,anada

V#': ganda Virus #esear-h 'nstitute

"ADD&: the "oreign Ani(al Disease Diagnosti- &aboratory

+##S: +or-ine #e.rodu-tive and #es.iratory Syndro(e /0

D#,: De(o-rati- #e.ubli- o% ,ongo

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Abstract:

!he tre(endous outbrea* o% Ebola virus disease o--urring in West A%ri-a sin-e the

end o% 1234 sur.rises by its re(oteness %ro( .revious e.ide(i-s and dra(ati- e5tent6

!his revie7 ai(s to des-ribe the 18 (ani%estations o% Ebola virus that arose a%ter its

dis-overy in 3986 't .rovides an u.date on resear-h on the e-ology o% Ebola viruses;

(odes o% -onta(ination and hu(an trans(ission o% the disease that are (ainly lin*ed to

-lose -onta-t 7ith an in%e-ted ani(al or a .atient su%%ering %ro( the disease6 !he

re-o((endations to -ontain the e.ide(i- and -hallenges to a-hieve it are re(inded6

!hrough this .a.er; 7e are going to have a clearer idea about the situation standing

%or the virus that s.read terror 7ithin the so-iety6

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Introduction:

!he outbrea* o% Ebola virus disease /EVD0 o--urring in West A%ri-a sin-e De-e(ber

1234 7ill (ar* the history < ho7ever brie% < o% the viruses6 O--urring %or the %irst ti(e

outside its original ho(e < the ,entral A%ri-an rain%orest < this e.ide(i- o% EVD a..ears as

the deadliest and longest o% all those *no7n so %ar6 At this ti(e /August 3=th; 123>0; (ore

than 3;1=2 deaths have been re.orted; i.e. %ive ti(es (ore than during the 7orst .revious

outbrea*6 'n addition; its ra.id .ro.agation has led the World Health Organization /WHO0 to

de-lare on August ?th that EVD re.resent a @+ubli- Health E(ergen-y o% 'nternational

,on-ern and urged the international -o((unity to ta*e a-tion to sto. the s.read6 "inally; %or

the %irst ti(e; in res.onse to the severity o% the situation; WHO agreed the use o%

e5.eri(ental treat(ent against the EVD6

1. Basic information about Ebola virus:

!he Ebola virus is *no7 as being a %atal illness i% it is not dete-ted and treated6 !his

virus; a..eared %irst in t7o si(ultaneous outbrea*s in398;one in zara; Sudan; and the

other in Ca(bu*u; De(o-rati- #e.ubli- o% ,ongo6 !he latter o--urred in a village near

the Ebola #iver; %ro( 7hi-h the disease ta*es its na(e6

!he -urrent outbrea* in West A%ri-a; /%irst -ases re.orted in $ar-h 123>0; is the largest

and (ost -o(.le5 e.ide(i- o% Ebola sin-e the Ebola virus 7as dis-overed in 398; there

7ere (ore -ases and deaths in this e.ide(i- that all the others -o(bined6 't has also s.read

a-ross -ountries starting in uinea and then s.read a-ross the land borders 7ith Sierra &eone

and &iberia; by air /3 traveler only0 in igeria; and by land /3 traveler0 Senegal6

!he -ountries (ost a%%e-ted uinea; Sierra &eone and &iberia have very 7ea* health

syste(s la-* the hu(an resour-es and in%rastru-ture; having re-ently e(erged %ro( long

.eriods o% -on%li-t and instability6 August ?; WHO Dire-tor)eneral said a .ubli- health

e(ergen-y o% international -on-ern this e.ide(i-6

. Ebola virus disease:

Ebola; .reviously *no7n as Ebola he(orrhagi- %ever; is a severe; o%ten %atal disease in

hu(ans and nonhu(an .ri(ates /su-h as (on*eys; gorillas; and -hi(.anzees06

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Ebola is a rare and deadly disease -aused by in%e-tion 7ith a virus o% the %a(ily Filoviridae;

genus Ebolavirus6 !here are %ive identi%ied Ebolavirus s.e-ies; %our o% 7hi-h have -aused

disease in hu(ans: Zaire ebolavirus Sudan ebolavirus Ta Forest ebolavirus; %or(erly Cte

d’Ivoire ebolavirus and Bundibugyo ebolavirus6 !he %i%th; Reston ebolavirus; has -aused

disease in nonhu(an .ri(ates but not in hu(ans6

Ebola is %ound in several A%ri-an -ountries6 !he %irst Ebola s.e-ies 7as dis-overed in 398

near the Ebola #iver in 7hat is no7 the De(o-rati- #e.ubli- o% the ,ongo6 Sin-e then;

outbrea*s have a..eared s.oradi-ally in A%ri-a6

!he natural reservoir host o% Ebola re(ains un*no7n6 Ho7ever; on the basis o% available

eviden-e and the nature o% si(ilar viruses; resear-hers believe that the virus is ani(al)borne7ith bats being the (ost li*ely reservoir6 "our o% the %ive subty.es o--ur in an ani(al host

native to A%ri-a6

Ebola virus disease /%or(ly *no7n as Ebola hae(orrhagi- %ever0 is a severe; o%ten %atal

illness in hu(ans6 !he -ase %atality rate %or Ebola virus disease -an be as high as 92F6

enus Ebolavirus is one o% three (e(bers o% the "iloviridae %a(ily /%ilovirus0; along 7ith

genus $arburgvirus and genus ,uevavirus6 enus Ebolavirus -o(.rises %ive distin-t s.e-ies:

• Zaïre ebola virus /EBOV0

• Bundibuygyo ebola virus /BDBV0

• Sudan ebola virus /SDV0

• !aï "orest ebola virus /!A"V0

• #eston ebola virus /#ES!V0

BDBV; EBOV; and SDV have been asso-iated 7ith large Ebola virus disease outbrea*s in

A%ri-a; 7hereas #ES!V and !A"V have not6 !he #ES!V s.e-ies %ound in +hili..ines and

the .eo.leGs #e.ubli- o% ,hina; -an in%e-t hu(ans; but no illness or death in hu(ans %ro(

this s.e-ies has been re.orted to date6

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'n this outbrea*; viral seuen-ing -ondu-ted by the 'nstitute +asteur in &yon; "ran-e; sho7

strong ho(ology /9?F0 7ith Zaïre Ebolavirus6

!. Occurrence and e"idemiolo#y:

Human cases of Ebola virus disease to date

&aboratory)-on%ir(ed -ases o% hu(an in%e-tion 7ith Zare Ebola virus have been re.orted

so %ar to World Health Organization /WHO0 by the $inistry o% Health o% uinea /$OH

uinea0; the $inistry o% Health I So-ial Wel%are o% &iberia /$OHSW &iberia0; and the

$inistry o% Health and Sanitation o% Sierra &eone /$OHS Sierra &eone06

!he -ases o--urred in an initial 7ave %ro( January to $ay 123>; 7hen 4 -ases 7ere

re.orted on 13 $ar-h in uinea6 Subseuent -ases 7ere re.orted by the $OHSW &iberia on

43 $ar-h6 Sin-e $ay 123>; a se-ond 7ave o% hu(an -ases has been o--urring; in-luding a

se-ond outbrea* re.orted by the $OHSW &iberia on 19 $ay6 Also on 1 $ay; $OHS Sierra

&eone re.orted an outbrea*6

"date on cases and deat*s in /uinea

As o% 11 June 123>; $OH uinea re.orts a total o% 492 -ases o% Ebola virus disease /182

-on%ir(ed; ?9 .robable; and 43 sus.e-ted0 in-luding 184 deaths /3= -on%ir(ed; ?3 .robable;

and 18 sus.e-ted06

"date on cases and deat*s in Liberia

As o% 14 June 123>; $OHSW &iberia re.orts a total o% 1 -ases o% Ebola virus disease /4=

-on%ir(ed; 32 .robable; and 38 sus.e-ted0 in-luding 48 deaths /14 -on%ir(ed; 32 .robable;

and > sus.e-ted06

"date on cases and deat*s in 0ierra Leone

As o% 14 June 123>; $OHS Sierra &eone re.orts 3 -ases o% Ebola virus disease /3=

-on%ir(ed; ? .robable; and 1 sus.e-ted0 in-luding >8 deaths /49 -on%ir(ed; ? .robable; and 2

sus.e-ted0 /due to di%%i-ulties in -olle-ting a--urate in%or(ation %ro( the %ield; the nu(ber o%

deaths is largely underesti(ated in Sierra &eone06

Cumulative cases of and deat*s from Ebola virus disease

,u(ulatively; 3? -ases o% Ebola virus disease />3 -on%ir(ed; 328 .robable; and =2

sus.e-ted0 and 4=8 deaths /118 -on%ir(ed; 99 .robable; 43 sus.e-ted0 have been re.orted

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a-ross the three -ountries6 !he -u(ulative -ase %atality rate is =?F6 "i%ty one /=30 health)-are

7or*ers have been in%e-ted during this outbrea* /1? in uinea; 4 in &iberia; and 12 in Sierra

&eone06

i#ure 1: E"i curve of Ebola virus disease outbreak in 2est Africa 3/uinea+ Liberia+

and 0ierra Leone4+ by 5eek of onset+ &ecember 61! 7 8une 61$ 1

$. Ty"es of transmissions:

!he in-ubation .eriod; that is; the ti(e interval %ro( in%e-tion 7ith the virus to onset o%

sy(.to(s is 1 to 13 days6 Hu(ans are not in%e-tious until they develo. sy(.to(s6 "irst

sy(.to(s are the sudden onset o% %ever %atigue; (us-le .ain; heada-he and sore throat6 !his

is %ollo7ed by vo(iting; diarrhea; rash; sy(.to(s o% i(.aired *idney and liver %un-tion; and

in so(e -ases; both internal and e5ternal bleeding /e6g6 oozing %ro( the gu(s; blood in the

stools06 &aboratory %indings in-lude lo7 7hite blood -ell and .latelet -ounts and elevated

liver enzy(es6

1 Data used to %or( this e.i-urve is -ontinually being revie7ed and u.dated as -ases are laboratory)-on%ir(ed6So(e have been esti(ated these esti(ates 7ere (ade based on the best available in%or(ation at the ti(e6 !hise.i-urve is as o% 14 June 123> nK286

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+eo.le (ay then be-o(e in%e-ted through -onta-t 7ith in%e-ted ani(als; either in the

.ro-ess o% slaughtering or through -onsu(.tion o% blood; (il*; or ra7 or under-oo*ed

(eat6

Ebola is introdu-ed into the hu(an .o.ulation through -lose -onta-t 7ith the blood;

se-retions; organs; or other bodily %luids o% in%e-ted ani(als6 'n A%ri-a; in%e-tion has been

do-u(ented through the handling o% in%e-ted -hi(.anzees; gorillas; %ruit bats; (on*eys;

%orest antelo.e; and .or-u.ines %ound ill or dead or in the rain%orest6

Ebola then s.reads in the -o((unity through hu(an)to)hu(an trans(ission; 7ith in%e-tion

resulting %ro( dire-t -onta-t through bro*en s*in or (u-ous (e(branes 7ith the blood;

se-retions; organs; or other body %luids o% in%e-ted; sy(.to(ati- .ersons; and indire-t -onta-t

7ith environ(ents -onta(inated 7ith su-h %luids6 !rans(ission does not o--ur during the

in-ubation .eriod and only o--urs on-e an in%e-ted .erson .resents 7ith sy(.to(s6 Burial

-ere(onies in 7hi-h (ourners have dire-t -onta-t 7ith the body o% the de-eased .erson -an

also .lay a role in the trans(ission o% Ebola6 $en 7ho have re-overed %ro( the disease -an

still trans(it the virus through their se(en %or u. to 4 (onths a%ter re-overy6

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Health)-are 7or*ers have %reuently been in%e-ted 7hile treating sy(.to(ati- .atients

in%e-ted 7ith Ebola virus disease6 !his (ay o--ur through -lose -onta-t 7ith .atients 7hen

in%e-tion -ontrol .re-autions are not stri-tly .ra-ti-ed; in-luding basi- (easures < su-h as

hand hygiene < that should be a..lied even be%ore a .atient is sus.e-ted o% being in%e-ted

7ith Ebola virus disease6

%. &ia#nosis:

't -an be di%%i-ult to distinguish EVD %ro( other in%e-tious diseases su-h as (alaria;

ty.hoid %ever and (eningitis6 ,on%ir(ation that sy(.to(s are -aused by Ebola virus

in%e-tion are (ade using the %ollo7ing investigations:

o Antibody)-a.ture enzy(e)lin*ed i((unosorbent assay /E&'SA0

o Antigen)-a.ture dete-tion tests

o Seru( neutralization test

o #everse trans-ri.tase .oly(erase -hain rea-tion /#!)+,#0 assay

o Ele-tron (i-ros-o.y

o Virus isolation by -ell -ulture6

Sa(.les %ro( .atients are an e5tre(e biohazard ris* laboratory testing on non)ina-tivated

sa(.les should be -ondu-ted under (a5i(u( biologi-al -ontain(ent -onditions6

&aboratory tests used in diagnosis in-lude:

!i(eline o% 'n%e-tion Diagnosti- tests available

Within a %e7 days a%ter

sy(.to(s begin

• Antigen)-a.ture enzy(e)lin*ed i((unosorbent assay

/E&'SA0 testing

• 'g$ E&'SA

• +oly(erase -hain rea-tion /+,#0

• Virus isolation

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&ater in disease -ourse

or a%ter re-overy

• 'g$ and 'g antibodies

#etros.e-tively in

de-eased .atients

• '((unohisto-he(istry testing

• +,#

• Virus isolation

'. (ublic )ealt* care issues+ "revention and control:

ood outbrea* -ontrol relies on a..lying a .a-*age o% interventions; na(ely -ase

(anage(ent; surveillan-e and -onta-t tra-ing; a good laboratory servi-e; sa%e burials and

so-ial (obilisation6 ,o((unity engage(ent is *ey to su--ess%ully -ontrolling outbrea*s6

#aising a7areness o% ris* %a-tors %or Ebola in%e-tion and .rote-tive (easures thatindividuals -an ta*e is an e%%e-tive 7ay to redu-e hu(an trans(ission6 #is* redu-tion

(essaging should %o-us on several %a-tors:

-educin# t*e risk of 5ildlife9to9*uman transmission %ro( -onta-t 7ith in%e-ted

%ruit bats or (on*eysLa.es and the -onsu(.tion o% their ra7 (eat6 Ani(als should be

handled 7ith gloves and other a..ro.riate .rote-tive -lothing6 Ani(al .rodu-ts

/blood and (eat0 should be thoroughly -oo*ed be%ore -onsu(.tion6

-educin# t*e risk of *uman9to9*uman transmission %ro( dire-t or -lose

-onta-t 7ith .eo.le 7ith Ebola sy(.to(s; .arti-ularly 7ith their bodily %luids6

loves and a..ro.riate .ersonal .rote-tive eui.(ent should be 7orn 7hen ta*ing

-are o% ill .atients at ho(e6 #egular hand 7ashing is reuired a%ter visiting .atients in

hos.ital; as 7ell as a%ter ta*ing -are o% .atients at ho(e6

Outbreak containment measures in-luding .ro(.t and sa%e burial o% the

dead; identi%ying .eo.le 7ho (ay have been in -onta-t 7ith so(eone in%e-ted 7ith

Ebola; (onitoring the health o% -onta-ts %or 13 days; the i(.ortan-e o% se.arating the

healthy %ro( the si-* to .revent %urther s.read; the i(.ortan-e o% good hygiene and

(aintaining a -lean environ(ent6

Health)-are 7or*ers should al7ays ta*e standard .re-autions 7hen -aring %or .atients;

regardless o% their .resu(ed diagnosis6 !hese in-lude basi- hand hygiene; res.iratory

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hygiene; use o% .ersonal .rote-tive eui.(ent /to blo-* s.lashes or other -onta-t 7ith

in%e-ted (aterials0; sa%e inje-tion .ra-ti-es and sa%e burial .ra-ti-es6

Health)-are 7or*ers -aring %or .atients 7ith sus.e-ted or -on%ir(ed Ebola virus should

a..ly e5tra in%e-tion -ontrol (easures to .revent -onta-t 7ith the .atientGs blood and

body %luids and -onta(inated sur%a-es or (aterials su-h as -lothing and bedding6 When

in -lose -onta-t /7ithin 3 (eter0 o% .atients 7ith EBV; health)-are 7or*ers should 7ear

%a-e .rote-tion /a %a-e shield or a (edi-al (as* and goggles0; a -lean; non)sterile long)

sleeved go7n; and gloves /sterile gloves %or so(e .ro-edures06

&aboratory 7or*ers are also at ris*6 Sa(.les ta*en %ro( hu(ans and ani(als %or

investigation o% Ebola in%e-tion should be handled by trained sta%% and .ro-essed in suitably

eui..ed laboratories6

,. Outbreak nuisances and *istory:

2014: Ebola Outbreak in Democratic Republic of the Cono

On August 1; 123>; the De(o-rati- #e.ubli- o% the ,ongo /D#,0 $inistry o% Health

noti%ied the World Health Organization o% an outbrea* o% Ebola virus disease /EVD0 in

Euateur +rovin-e6 !he inde5 -ase 7as a .regnant 7o(an %ro( '*ana(ongo Village 7ho

but-hered a bush ani(al6 She be-a(e ill 7ith sy(.to(s o% EVD; re.orted to a .rivate -lini-

in 'sa*a Village; and died on August 33; 123>6 &o-al -usto(s and rituals asso-iated 7ith

death (eant that several health-are 7or*ers 7ere e5.osed to Ebola virus6

2014: Ebola Outbreak in !est "frica

!he 123> Ebola e.ide(i- is the largest in history; a%%e-ting (ulti.le -ountries in West A%ri-a6

One i(.orted -ase %ro( &iberia and asso-iated lo-ally a-uired -ases in health-are 7or*ers

have been re.orted in the nited States6 ,D, and .artners are ta*ing .re-autions to .revent

the %urther s.read o% Ebola 7ithin the nited States6 ,D, is 7or*ing 7ith other 6S6

govern(ent agen-ies; the World Health Organization; and other do(esti- and international

.artners and has a-tivated its E(ergen-y O.erations ,enter /EO,0 to hel. -oordinate

te-hni-al assistan-e and -ontrol a-tivities 7ith .artners6 ,D, has de.loyed tea(s o% .ubli-

health e5.erts to West A%ri-a and 7ill -ontinue to send e5.erts to the a%%e-ted -ountries6

12

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html#areashttp://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.htmlhttp://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.htmlhttp://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html#areas


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2012: Ebola Hemorrhaic #ever Outbreak in $anda

As o% De-e(ber 1; 1231; the gandan $inistry o% Health re.orted 8 -u(ulative -ases

/.robable and -on%ir(ed0 o% Ebola virus in%e-tion; in-luding > deaths; in the &u7ero Distri-t

o% -entral ganda6 ,D, assisted the $inistry o% Health in the e.ide(iologi- and diagnosti-

as.e-ts o% the outbrea*6 !esting o% sa(.les by ,D,Ms Viral S.e-ial +athogens Bran-h too*

.la-e at the ganda Virus #esear-h 'nstitute in Entebbe6 /#e.orted nu(bers are subje-t to

-hange06

2012: Ebola Hemorrhaic #ever Outbreak in Democratic Republic of Cono

!he D#, $inistry o% Health has de-lared an end to the (ost re-ent Ebola outbrea* in D#,Ms

+rovin-e Orientale6 !he ove(ber 1 +ress #elease re.orts a %inal total o% 88 -ases;

in-luding 4 laboratory)-on%ir(ed -ases; 38 .robable and 1> sus.e-t -ases; 7ith a total o% 4

deaths6 ,D, assisted the $inistry o% Health in the e.ide(iologi- and diagnosti- as.e-ts o%

the investigation6 &aboratory su..ort 7as .rovided both through ,D,Ms %ield laboratory in

'siro; and through the ,D,LV#' lab in ganda6 !he +ubli- Health Agen-y o% ,anada

/+HA,0 also .rovides diagnosti- su..ort through its %ield lab in 'siro6 !he outbrea* in D#,

has no e.ide(iologi- lin* to the near -onte(.oraneous Ebola outbrea* in the Nibaale distri-t

o% ganda6 /#e.orted nu(bers are subje-t to -hange06

2012: Ebola Hemorrhaic #ever Outbreak in $anda

On July 1?; 1231; the ganda $inistry o% Health re.orted an outbrea* o% Ebola He(orrhagi-

"ever in the Nibaale Distri-t o% ganda6 A total o% 1> hu(an -ases /.robable and -on%ir(ed

only0; 38 o% 7hi-h 7ere %atal; 7ere re.orted starting at the beginning o% July6 &aboratory tests

o% blood sa(.les; -ondu-ted by the ganda Virus #esear-h 'nstitute /V#'0 and the 6S6

,enters %or Disease ,ontrol and +revention /,D,0; -on%ir(ed Ebola virus in 33 .atients; %our

o% 7ho( died6 #e.orted nu(bers are subje-t to -hange6

On O-tober >; 1231; the ganda $inistry o% Health de-lared the outbrea* ended6

2011: Ebola Hemorrhaic #ever Case in $anda

On $ay 3>; 1233; the gandan $inistry o% Health in%or(ed the .ubli- that a .atient 7ith

sus.e-ted Ebola He(orrhagi- %ever died on $ay ; 1233 in the &u7ero distri-t; ganda6

,D,)ganda -on%ir(ed a .ositive Ebola virus test result %ro( a blood sa(.le ta*en %ro( the

.atient6 !he ui-* diagnosis o% Ebola virus 7as .rovided by the ne7 ,D, Viral He(orrhagi-

"ever laboratory installed at the ganda Viral #esear-h 'nstitute /V#'06

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E5.erts %ro( the ,D, have arrived in Entebbe; ganda to a-tively assist the gandan

$inistry o% Health; lo-al health o%%i-ials; and international organizations in disease res.onse6

At the .resent ti(e; there are no other *no7n -ases6

200%: Ebola&Reston virus detected in pis in 'hilippines

On O-tober 1=; 122?; ,D, re-eived sa(.les o% .ig tissues; sera and -ell -ultures %ro(

"ADD&; the "oreign Ani(al Disease Diagnosti- &aboratory on +lu( 'sland; C6 !he

sa(.les; originally -olle-ted %ro( .ig %ar(s outside $anila; 7ere initially tested at the +lu(

'sland %a-ility; 7hi-h identi%ied (ulti.le s7ine .athogens; in-luding +or-ine #e.rodu-tive

and #es.iratory Syndro(e /+##S0 virus and .or-ine -ir-ovirus ty.e 16 Additional testing by

(ole-ular analysis also tentatively identi%ied; %or the %irst ti(e in .igs; Ebola)#eston virus6

"urther testing o% the sa(.les at ,D,Gs S.e-ial +athogens Bran-h and 'n%e-tious Disease

+athology Bran-h -on%ir(ed the .resen-e o% Ebola)#eston virus6 Seuen-e analysis

-ondu-ted at "ADD& and ,D, revealed that the virus is si(ilar to the Ebola)#eston virus

that in%e-ted (a-aues %ro( the +hili..ines i(.orted into the S %or resear-h in 39?9; 3992

and 399; and into 'taly in 39916

!he -lini-al signi%i-an-e o% Ebola)#eston in .igs is un*no7n; sin-e (any o% the sa(.les

7ere obtained %ro( .igs 7ith dual +##SV and Ebola)#eston virus in%e-tions6 E.ide(iologi-

investigations by +hili..ine authorities are -ontinuing to loo* %or eviden-e o% hu(an disease

asso-iated 7ith in%e-ted .igs6 Ebola)#eston virus is o% un*no7n .athogeni-ity in hu(ans6

#e-ent studies o% s(all nu(bers o% +hili..ine slaughterhouse 7or*ers revealed antibodies to

Ebola)#eston virus; 7ith no -lini-al disease6

200(: Ebola Hemorrhaic #ever Outbreak in $anda

On ove(ber 1; 1228; ,D, re-eived blood sa(.les %ro( the gandan $inistry o% Health;

ta*en %ro( 12 o% the >9 .atients involved in an outbrea* o% an un*no7n illness in

Bundibugyo distri-t in 7estern ganda6 +atients re.orted %ever; enteritis; and bleeding6 O%

the >9; 3> have died6 eneti- seuen-ing o% a s(all seg(ent o% viral #A %ro( sa(.les

indi-ated the .resen-e o% a .reviously un*no7n strain o% Ebola virus6 At the invitation o% the

gandan $inistry o% Health; ,D,; WHO; $S" and other -ollaborators de.loyed %ield

investigators to the a%%e-ted region additionally; a laboratory 7as set u. in Entebbe at the

ganda Virus #esear-h 'nstitute /V#'06 As the outbrea* neared -on-lusion in January 122?;

the total nu(ber o% sus.e-ted -ases 7as 3>9; 7ith 48 deaths6

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200(: Ebola Hemorrhaic #ever Outbreak in the Democratic Republic of Cono )DRC*

On August 1?; 1228; ,D, 7as noti%ied o% -ases o% an unidenti%ied disease in a re(ote area o%

Nasai O--idental +rovin-e in the De(o-rati- #e.ubli- o% ,ongo /D#,06 ,lini-al sa(.les

7ere sent to the ,D, S.e-ial +athogens Bran-h laboratory %or testing; as 7ell as to the

,entre 'nternational de #e-her-hes $di-ales de "ran-eville /,'#$"0 laboratory in abon6

#esults obtained by both #eal !i(e +,# and viral antigen assay 7ere .ositive %or in%e-tion

7ith Ebola virus6 !he .resen-e o% other diseases in the sa(e area o% the -ountry -ontributing

to the outbrea* -annot be ruled out6 At the invitation o% the D#, $inistry o% Health; ,D,;

WHO; $S" and other -ollaborators have de.loyed %ield investigators to the region6 !he onset

o% the latest laboratory)-on%ir(ed -ase 7as on Se.te(ber 19; 12286 On O-tober 3; 1228; the

total o% sus.e-ted -ases 7as 1>9 7ith 3?4 deaths6

2004: Ebola Hemorrhaic #ever Outbreak in south +udan

A--ording to the World Health Organization /WHO0; 12 -ases; in-luding = deaths; %ro(

Ebola he(orrhagi- %ever /EH"0 have been re.orted %ro( Ca(bio ,ounty in southern Sudan6

EH" has been laboratory -on%ir(ed by both the ,enters %or Disease ,ontrol and +revention

/,D,0 and the Nenya $edi-al #esear-h 'nstitute6 ,D, has -on%ir(ed that the virus is the

Ebola)Sudan strain /in-ubation .eriod: 1)13 days0; one o% three .reviously re-ognized Ebola

virus strains *no7n to -ause hu(an disease6

200,: Ebola Hemorrhaic #ever Outbreak in -he Republic of the Cono

2002: Ebola Hemorrhaic #ever Outbreak in .abon and -he Republic of the Cono

On $ay ; 1221; the abonese $inistry o% Health de-lared that the Ebola he(orrhagi- %ever

outbrea* in the Ogoou)'vindo .rovin-e had ended6 ,D, .arti-i.ated 7ith the abonese and

,ongolese $inistries o% Health; the World Health Organization /WHO0; the 'nternational

,enter %or $edi-al #esear-h in "ran-eville; abon; and other .artners in an international

res.onse to the outbrea* in the Ogoou)'vindo .rovin-e o% abon and in neighboring villages

in the #e.ubli- o% the ,ongo6

Ebola he(orrhagi- %ever is a severe; o%ten %atal viral he(orrhagi- disease6 !he virus -an be

trans(itted by -lose -onta-t 7ith .ersons sy(.to(ati- 7ith the disease6 On the basis o%

e5tensive studies o% .revious outbrea*s o% Ebola he(orrhagi- %ever; general travelers in the

area are unli*ely to -ontra-t the disease6 Ho7ever; travelers are advised to ta*e a..ro.riate

.re-autions to .revent in%e-tion6 !hese .re-autions in-lude avoiding dire-t -onta-t 7ith

.eo.le 7ho have serious disease and their bodily %luids6

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2000&2001: Ebola Hemorrhaic #ever Outbreak in $anda

On "ebruary 18; 1223; ganda 7as de-lared o%%i-ially to be %ree o% Ebola he(orrhagi- %ever;

%ollo7ing a >1)day .eriod; t7i-e the (a5i(u( in-ubation .eriod; during 7hi-h no ne7 -ases

had been re.orted6

Bet7een O-tober 1222 and "ebruary 1223; ,D, .arti-i.ated 7ith the World Health

Organization /WHO0; the gandan $inistry o% Health; $ede-ins Sans "rontieres /$S"0; and

other .artners in an international res.onse to the outbrea*6

Conclusion:#e-ently dis-overed in ,entral A%ri-a; the Ebola viruses -aused li(ited; but high)(ortality

e.ide(i-s6 "ruit bats are .robably the reservoir o% the virus6 !he initial hu(an in%e-tion

results %ro( -onta-t 7ith in%e-ted bush (eat; and usually ta*es .la-e in .oor and ina--essible

areas6 Se-ondary trans(ission o--urs during .atient -are at ho(e; %uneral rites or hos.ital

disse(ination due to the la-* o% .reventive (easures and be-ause o% inadeuate training o%

health .ersonnel 7ith good (edi-al .ra-ti-e6

!he di%%i-ult diagnosis; the resistan-e o% the .o.ulation and the relu-tan-e o% authorities

e5.lain the slo7 and li(ited res.onse to outbrea*s; and the ra.id s.read o% the e.ide(i- that

be-o(es hard to -ontrol6

#e-ently; the overn(ent o% ,anada 7ill shi. ?22 vials o% its e5.eri(ental Ebola va--ine to

the World Health Organization /WHO0 in eneva; beginning 7ith its %irst shi.(ent on

$onday; O-tober 12; 123>6

!he va--ine vials are being sent in three se.arate shi.(ents; as a .re-autionary (easure; due

to the -hallenges in (oving a va--ine that (ust *e.t at a very lo7 te(.erature at all ti(es6

!he +ubli- Health Agen-y o% ,anada is su..lying the va--ine to the WHO in its role as the

international -oordinating body %or the Ebola outbrea*; so that the va--ine -an be (ade

available as an international resour-e6

!he World Health Organization; in -onsultation 7ith .artners; in-luding the health authorities

%ro( the a%%e-ted -ountries; 7ill guide and %a-ilitate ho7 the va--ine is distributed and used6

!here are both ethi-al and logisti-al -hallenges 7ith the use o% e5.eri(ental va--ines and

treat(ents in hu(ans and the WHO is -onsidering the( -are%ully be%ore using the va--ine in

this outbrea*6

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On O-tober 34; 123>; the overn(ent o% ,anada announ-ed the start o% -lini-al trials %or the

va--ine at the Walter #eed Ar(y 'nstitute o% #esear-h in the nited States6 !hese trials 7ill

.rovide -riti-al in%or(ation about the sa%ety o% the va--ine and 7hat dose is reuired to

sti(ulate a .ersonGs i((une syste( to .rodu-e Ebola antibodies6 #esults %ro( the -lini-al

trial are e5.e-ted in De-e(ber 123>6

-eferences:

*tt":555.5*o.inten

*tt":555.e"a.#ov

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Ebola Virus Outbreak

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