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Ebola Hemorrhagic Fever Deadly African Virus

Dr. Hythum Salah H. Mohamed NGHA -KAMC-Riyadh 6th August 2014

Historical Background

Ebola first appeared in 1976 in 2 simultaneous outbreaks, first in Nzara which is small town in south of Sudan which infected over 284 people, with a mortality rate of 53%.

After view month another out break occurred in Yambuku in Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name

In Congo outbreak 318 people infected with highest mortality rate of 88% .

www.who.int

WWW.web.stanford.edu

Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014

http://www.who.int/

http://www.web.stanford.edu/

Ebola Outbreaks

24 outbreaks reported by WHO from 1976 till 2012 .

first outbreak occurred in Sudan( Newly south of Sudan ) and Democratic Republic of Congo with mortality rate of 53% and 88% respectively .

Countries involved in outbreaks was , Sudan , Congo , Uganda ,Gabon , South Africa ( one case in 1996 ) and Cote d'Ivoire ( one case in 1994).

No case reported out of Africa till 2012 .

The maximum No of infected patients was 425 in Uganda outbreak 2000 .

www.who.int


http://www.who.int/

Ebola 2014 Outbreak

August 1, 2014, the Guinea Ministry of Health announced a total of 485 suspect and confirmed cases of Ebola virus disease (EVD), including 358 fatal cases.

340 cases across Guinea have been confirmed by laboratory testing to be positive for Ebola virus infection.

August 1, 2014, the Ministry of Health and Sanitation of Sierra Leone and WHO reported a cumulative total of 646 suspect and confirmed cases, including 540 laboratory confirmations and 273 reported fatal cases.

www.cdc.gov update 4th August 2014


http://www.cdc.gov/

August 1, 2014, the Ministry of Health and Social Welfare of Liberia and WHO have reported 468 suspect and confirmed EHF cases (including 129 laboratory confirmations) and 255 reported fatalities.

August 1, 2014, the Nigerian Ministry of Health and WHO reported 4 suspect and probable cases and 1 fatal probable case.

Nigerian Suspected and Confirmed Case Count are 4 .

www.cdc.gov update 4th August 2014

http://www.cdc.gov/

Geographical Map of 2014 Outbreak

Genus of Ebola Virus

Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus.

Genus Ebolavirus comprises 5 distinct species:

1-Bundibugyo ebolavirus (BDBV)

2-Zaire ebolavirus (EBOV)

3-Reston ebolavirus (RESTV)

4-Sudan ebolavirus (SUDV)

5-Taï Forest ebolavirus (TAFV).

www.who.int


http://www.who.int/

Bundibugyo , Zaire and Sudan Ebola virus species are associated with have with large Ebola virus disease outbreaks in Africa .

Reston ebolavirus (RESTV) and Taï Forest ebolavirus (TAFV) have not associated with EVD in Africa .

The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

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http://www.who.int/

Transmission of EVD .

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals.

In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids.

www.who.int


http://www.who.int/

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.

Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children.

www.who.int


http://www.who.int/

Natural host of Ebola virus

In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus.

www.who.int


http://www.who.int/

Signs and Symptoms of Ebola Haemorrhagic Fever

Fever (90%-100%)

Headache (40%-90%)

Chills

Myalgia/arthralgia (40%-80%)

Malaise (75%-85%)

Pharyngitis (20%-40%)

Loss of appetite

Vomiting (59%)

Hematemesis (10%-40%)

Non-bloody diarrhea (81%)

http://web.stanford.edu/group/virus/filo/humandiseases.htm

l Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014

http://web.stanford.edu/group/virus/filo/humandiseases.html



Blood fails to clot (71%-78%)

Abdominal pain (60-80%)

Dry and sore throat (63%)

Chest pain (83%)

Hemorrhagic diathesis (71%-78%)

Maculopapular rash (5%-20%)

Hiccups (15 %)

Hepatic damage

Renal failure http://web.stanford.edu/group/virus/filo/humandiseases.html





CNS involvement (infrequently)

Terminal shock

Lymphopenia

Severe thrombocytopenia

Transaminase elevation

Hyperamylasemia

During the convalescent stage:

1-Loss of memory

2-Central nervous system disorders

3-Loss of hair





Diagnosis

Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:

1-antibody-capture enzyme-linked immunosorbent assay (ELISA)

2-antigen detection tests

3-serum neutralization test

4-reverse transcriptase polymerase chain reaction (RT-PCR) assay

5-electron microscopy

6-virus isolation by cell culture.

www.who.int


http://www.who.int/

Treatment

No specific treatment is available .

Standard treatment for Ebola HF is still limited to supportive therapy. This consists of:

1-balancing the patient’s fluids and electrolytes

2-maintaining their oxygen status and blood pressure

3-treating them for any complicating infections .

www.cdc.gov


http://www.cdc.gov/

During the 1995 Ebola Zaire outbreak in Kikwit, whole blood from convalescent patients was administered to eight patients late in their clinical course . Only one patient died, suggesting that even small amounts of transfused blood had a beneficial effect. However, a subsequent analysis demonstrated that, due to good prognostic factors, these patients would have likely survived without any intervention .

convalescent serum , interferon-alpha , Ribavirin , immune globulin and plasma exchange are tried but not provided evidence of therapeutic efficacy .

www.uptodate.com


http://www.uptodate.com/

Post exposure prophylaxis

At this time, there are no FDA-approved forms of post exposure prophylaxis for Ebola HF.

In Animal experiments Interferon-alpha showed effectiveness .

In a very promising approach to postexposure prophylaxis, an experimental live-virus vaccine has been developed using recombinant vesicular stomatitis virus (VSV) encoding the Marburg or Ebola surface glycoproteins. A single injection is completely protective as a standard preexposure vaccine

www.uptodate.com


http://www.uptodate.com/

Infection ControlControlling infection in health-care settings

it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times .

These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment and safe injection practices and safe burial practices.

When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

www.who.int


http://www.who.int/

face shields or surgical masks and eye protection (e.g., goggles or eyeglasses with side shields) should be worn by persons coming within approximately 3 feet of the patient.

Patients who are hospitalized or treated in an outpatient healthcare setting should be placed in a private room and Standard, Contact, and Droplet Precautions should be initiated .

Nonessential staff and visitors should be restricted from entering the room of patients with suspected VHF. www.cdc.gov/vhf/abroad/pdf/vhf-interim-guidance.pdf-2005.


http://www.cdc.gov/vhf/abroad/pdf/vhf-interim-guidance.pdf-2005

http://www.cdc.gov/vhf/abroad/pdf/vhf-interim-guidance.pdf-2005

Laboratory workers are also at risk.

Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.

www.who.int


http://www.who.int/

Reducing the risk of Ebola infection in people

raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat

handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

www.who.int


http://www.who.int/

Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided.

Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home and burial of the dead .

www.who.int


http://www.who.int/

Ebola Reported Outside Africa

Ebola in Saudi Arabia








Ebola in Saudi Arabia Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014