EBOLA

A
EMERGING THREAT
Dr.T.V.Rao MD
Discovery of EBOLA
Ebola viruses are found
in several African
countries. Ebola was
first discovered in 1976
near the Ebola River in
what is now the
Democratic Republic of
the Congo. Since then,
outbreaks have
appeared sporadically
in Africa.
Dr.T.V.Rao MD 2
Origin of Ebola virus remains
unknown
The natural reservoir host of
Ebola virus remains
unknown. However, on the
basis of evidence and the
nature of similar viruses,
researchers believe that the
virus is animal-borne and
that bats are the most likely
reservoir. Four of the five
virus strains occur in an
animal host native to Africa.
Dr.T.V.Rao MD 3
Ebola and Marburg Virus
Ebola and Marburg viruses are
highly virulent in humans and
non human primates, ends in
death.
Both the viruses are identified to
cause African hemorrhagic fevers
Dr.T.V.Rao MD 4
Filo virus
Filo is Latin for Thread
Marburg and Ebola are
members of the Filoviridae
Appear as long threads,
Can be U shaped,
Genome 19 kb long
Enveloped viruses.
A single stranded,
unregimented, -Helical, ve
sense RNA genome 80 nm
Diameter
Dr.T.V.Rao MD 5
Fruit Bats Harbour Virus
and Spread the Virus
Fruit bats are believed to be
the normal carrier in nature,
able to spread the virus
without being affected.
Humans become infected
by contact with the bats or a
living or dead animal that
has been infected by bats.
Dr.T.V.Rao MD 6
FRUIT BATS SPREAD THE
INFECTION
Ebola haemorrhagic fever
Ebola virus disease (EVD), Ebola haemorrhagic fever
(EHF) Ebola is a disease of humans and other
mammals caused by Ebola virus. Signs and
symptoms typically start between two days and three
weeks after contracting the virus, with a fever, sore
throat, muscle pain and headaches. Then, vomiting,
diarrhoea and rash usually follows, along with
decreased function of the liver and kidneys. Around
this time, infected people may begin to bleed both
within the body and externally. Death, if it occurs, is
typically six to sixteen days after symptoms appear
and is often due to low blood pressure from fluid los
Ebola haemorrhagic fever
Around this time, infected
people may begin to
bleed both within the
body and externally.
Death, if it occurs, is
typically six to sixteen
days after symptoms
appear and is often due
to low blood pressure
from fluid loss
Dr.T.V.Rao MD 9
Events on Ebola
Ebola virus were discovered in 1976 with
occurrence of two severe epidemics of
hemorrhagic fever in Sudan and Zaire.
The Epidemic involved > 500 persons and killed
> 400 infected individual.
The importance of epidemic lies with in each
outbreak hospital staff become infected through
close contact with patients, their blood and
excreta.
The mean time of death from onset to symptoms
is 7 8 days.
Dr.T.V.Rao MD 10
2014 Ebola virus epidemic in West
Africa
In March 2014, the World Health Organization (WHO)
reported a major Ebola outbreak in Guinea, a western
African nation Researchers traced the outbreak to a
two-year old child who died on 28 December 2013.
The disease then rapidly spread to the neighbouring
countries of Liberia and Sierra Leone. It is the largest
Ebola outbreak ever documented, and the first
recorded in the region
Dr.T.V.Rao MD 11
Spread of EBOLA
Dr.T.V.Rao MD 12
Reservoir Hosts
Reservoirs can be a Rodent or
Bat
Humans infected accidentally
Monkeys are not proved as
reservoirs as die with
infection early
Infected humans are rich
source of infections to others.
By direct contact with blood
and body fluids of infected
persons can spread the
disease
Dr.T.V.Rao MD 13
Spread of Infections
Transmission appears to be associated with
contamination of Blood, Blood stained body
fluids or tissues.
Nosocomial spread is common mode of
spread, Doctors and Nurses at risk when
attending the patients.
Transmission by sexual intercourse has been on
record from a case of man infecting his wife 83
days after initial infection.
Dr.T.V.Rao MD 14
Viral Replication
The viruses are grown in
variety of cell lines
including
Vero
M A 104
S W 13 cells
Filoviruses replicates in the
cytoplasam
Dr.T.V.Rao MD 15
Pathology and Pathogenesis
The viruses belong to
group of Filo viruses
The viruses have
tropism for Cells of
macrophage system
Dendritic cells
Interstitial fibroblasts
Endothelial cells
Dr.T.V.Rao MD 16
Progress of EBOLA
Mode of Spread
Infected Patient a Concern
to Health Workers
Virus infect Several Organs
High titer of viruses are
found in
Liver
Spleen,
Lungs
Kidneys
Blood
Other Body fluids
Dr.T.V.Rao MD 21
Symptoms
Symptoms usually begin with a sudden influenza-like
stage characterized by feeling tired, fever, pain in the
muscles and joints, headache, and sore throat. The
fever is usually greater than 38.3 C (100.9 F).This is
often followed by: vomiting, diarrheal and abdominal
pain. Shortness of breath and chest pain may occur
next along with swelling, headaches and confusion. In
about half of cases the skin may develop a
maculopapular rash.
How the Illness is Presented in
Marburg and Ebola
Fever
Head ache
Sore throat
Muscle pain
Abdominal pain,
Vomitting
Diarrhea
Incubation period 3 -9 days in Marburg
In Ebola 2 21 days.
Dr.T.V.Rao MD 23
Serious manifestation of
Ebola and Marburg
Internal and
External
bleeding,
Shock,
Death
Dr.T.V.Rao MD 24
When you suspect
EBOLA
When the diagnosis of EVD is suspected, the travel and
work history along with exposure to wildlife are important
factors to consider. The diagnosis is confirmed by isolating
the virus, detecting its RNA or proteins, or detecting
antibodies against the virus in a person's blood. Isolating
the virus by cell culture, detecting the viral RNA by
polymerase chain reaction (PCR) and detecting proteins by
enzyme-linked immunosorbent assay (ELISA) works best
early and in those who have died from the disease.
Detecting antibodies against the virus works best late in the
disease and in those who recover
Laboratory testing
Changes on laboratory tests as a result of Ebola virus
disease include a low platelet count in the blood, an
initially decreased white blood cell count followed by
an increase in the white blood cell count, elevated
levels of the liver enzymes alanine aminotransferase
(ALT) and aspartate aminotransferase (AST), and
abnormalities in clotting often consistent with
disseminated intravascular coagulation (DIC) such as
a prolonged prothrombin time, partial thromboplastin
time, and bleeding time
Diagnosis
can be difficult to distinguish EVD from other infectious diseases such
as malaria, typhoid fever and meningitis. Confirmation that symptoms
are caused by Ebola virus infection are made using the following
investigations:
antibody-capture enzyme-linked immunosorbent assay (ELISA)
antigen-capture detection tests
serum neutralization test
reverse transcriptase polymerase chain reaction (RT-PCR) assay
electron microscopy
virus isolation by cell culture.
Diagnosis
Viruses are isolated from
Blood by cell culture on
Vero cells ( Vero E 6 )
ELISA for antigen
detection
ELISA for IgM
RT - PCR
Dr.T.V.Rao MD 28
Infection control
The risk of transmission is increased
amongst Ebola caregivers. Recommended
measures when caring for people infected
with Ebola include barrier-isolation,
sterilizing equipment and surfaces, and
wearing protective clothing including masks,
gloves, gowns, and goggles If a person with
Ebola dies, direct contact with the body of
the deceased patient should be avoided
Control of Infection
Isolation facilities
within the Hospital
remain the most
important effective
measure.
Barrier nursing
remain the basic need
in control of infection
spread
Dr.T.V.Rao MD 30
WHO RECOMENDS
One step recommended by the World Health
Organization is the education of the general public of
the risk factors for Ebola infection and of the protective
measures individuals can take. These include
avoiding direct contact with infected people and
regular hand washing using soap and water. Bush
meat, an important source of protein in the diet of
some Africans, should be handled with appropriate
protective clothing and thoroughly cooked before
consumption.
Trends on QUARANTINE
Quarantine, also known as enforced isolation, is usually
effective in decreasing spread. Governments often
quarantine areas where the disease is occurring or
individuals who may transmit the disease outside of an
initial area. In the United States, the law allows quarantine
of those infected with Ebola viruses. During the 2014
outbreak, Liberia closed schools. On October 16, 2014,
some schools were closed in Ohio and Texas as a
precaution after one of two nurses who contracted Ebola
after caring for Dallas Ebola victim Thomas Eric Duncan,
had returned to the Cleveland area and may have been on
the same plane as some students, teachers and parents of
students from those schools.
The health care workers
should
Avoid
Infected Blood,
secretions,
Tissues,
Wastes
Dr.T.V.Rao MD 34
Treatment of Ebola
and Marburg
Antiviral drugs are not available
Interferon's are not effective
To date no Vaccine
Electrolyte corrections
Dealing with hemorrhagic complications.
Dr.T.V.Rao MD 35
WHO Declares as International
Public Health emergency
On 8 August 2014, the WHO declared the epidemic to
be an international public health emergency. Urging
the world to offer aid to the affected regions, the
Director-General said, "Countries affected to date
simply do not have the capacity to manage an
outbreak of this size and complexity on their own. I
urge the international community to provide this
support on the most urgent basis possible. By mid-
August 2014, Doctors Without Borders reported the
situation in Liberia's capital Monrovia as "catastrophic"
and "deteriorating daily".
Dr.T.V.Rao MD 36
Ebola and Bioterrorism
Ebola virus is classified as a biosafety level 4
agent, as well as a Category A bioterrorism
agent by the Centres for Disease Control and
Prevention. It has the potential to be weaponized
for use in biological warfare, and was
investigated by the Biopreparat for such use, but
might be difficult to prepare as a weapon of
mass destruction because the virus becomes
ineffective quickly in open air.
Dr.T.V.Rao MD 37
SIMPLE MEASURES
CAN SAVE US
Dr.T.V.Rao MD 38
HAND WASHING
THE MOST IMPORTANT
Dr.T.V.Rao MD 39
NEVER FORGET TO WEAR THE GLOVES AT
EVERY STAGE WHEN WE COME IN CONTACT
WITH PATIETNS AND SCECRETIONS
Dr.T.V.Rao MD 40
BE SCIENTIFIC IN APPROACH TO
YOUR SUSPECTED PATIENTS
Learn and Practice the Biosafety
as No infection is Trivial to life
Dr.T.V.Rao MD 42
FOLLOW BIOSAFETY AT
EVERY STAGE OF WORK
Dr.T.V.Rao MD 43
NEVER FORGET TO QURANTINE
THE SUSPECTED PATIETNS
Dr.T.V.Rao MD 44
Barrier Nursing remains the
only best option in Prevention
Dr.T.V.Rao MD 45
References and Resources
CDC on Ebola
WHO The current concepts on EBOLA
Google Images
Wikipedia resources on EBOLA
Dr.T.V.Rao MD 46
Ebola is Greater Biohazard
than we Imagine
Dr.T.V.Rao MD 47
OUR VISION TO FUTURE
In spite many advances in Science, Medicine and Technology we
deal with Infection and Biohazard in casual ways, not following many
simple procedures like Hand Washing. The AIDS, SARS,
INFLUENZA AND EBOLA Teaches many Lessons everyone's life is
at threat from patients and casual approaches will make the Doctors,
nurses, or families and the Society at Risk I wish all the
Microbiologists, and Public Health Professionals to take more active
interest to Improve the Awareness on Infection Control, Let us not
forget every fear and danger has some solutions, try practising the
BIOSAFTEY
Dr.T.V.Rao MD Professor of Microbiology
Dr.T.V.Rao MD 48
Created for Health
awareness on EBOLA
Dr.T.V.Rao MD
Email
[email protected]
Dr.T.V.Rao MD 49