Ebola
Posted: 25 Dec 2014, 16:08
Ebola Virus Disease
(Ebola hemorrhagic fever)
EPIDEMIOLOGY
It is a severe, often fatal, illness
It affects humans and nonhuman primates.
(e.g. fruit bats, monkeys and apes)
Death rate is up to 90%
First appeared in 1976 in two simultaneous outbreaks:
1. Congo (near Ebola river)
2. Sudan (in remote area)
Third outbreak occurred in the Philippines from
infected imported monkeys, in 1989.
Fourth outbreak is going in west Africa.
It started in Guinea, in March 2014 and has
spread to Liberia, Sierra Leone and Nigeria.
What is the causative organism?
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).
`
Ebola is a filamentous,
single-stranded RNA virus
How DOES INFECTIO START?
First infection occurs by Contact with blood, secretions and other body fluids of infected/dead animals
High risk animals are:
1. Fruit bats
2. Monkeys
3. Apes
Once a person comes in contact with infected
animal, it can spread within the community
from human to human
HOW DO PEOPLE BECOME INFECTED?
Infected persons/dead bodies are the sources of infection
Direct contact with
*Blood
* Secretions (stools, urine, saliva and semen)
* Body fluids
or contaminated items (clothes, linen, needles)
Route of entry through:
1. Non-intact skin
2. Mucous membrane
So infection spreads through:
1. Unsafe case management
2. Unsafe burial practices
Infectivity period
Incubation period: 2-21 days
Infectivity begins with start of symptoms
(not during IP)
Patients are infectious as long as they
contain the virus in their blood and sections
Infected patients should be monitored clinically and by lab investigations, to determine that they are no more infectious to others, before they return home
Men recovered from illness can still spread
the virus to their partners, through semen up to
7 weeks after recovery (sexual intercourse is
prohibited through this period).
Who is at risk of infection?
HCWs
Family members or others in close contact with
infected persons
Hunters in the rain forest who come on contact
with dead animals
Mourners who have direct contact with deceased bodies (as part of burial ceremonies)
More studies are needed to understand if some
groups are more susceptible than others to
Contacting the virus:
Immunocopromised
People with underlying conditions/diseases
What are the typical signs an symptoms?
Typical symptms
Sudden onset of fever
Intensive weakness
Muscle pains
Headache
Sore throat
Followed by:
Vomiting
Diarrhea
Rash
Impaired kidney and liver functions
In some cases:
Bleeding (internal and external)
Lab findings (confirmatory diagnosis):
Decreased WBCs
Decreased platelets
Increased liver enzymes
Antibody-capture enzyme-linked immunosorbent assay (ELISA)
Antigen detection tests
Serum neutralization testreverse transcriptase polymerase chain reaction (RT-PCR) assay
Virus isolation by cell culture
When should a person seek for
medical care?
Any person who:
Has been in an area known to have the disease
In contact with a person known or suspected
to have the disease
And , begins to have symptoms
should seek prompt medical care
What is the tratment?
NO SPECIFIC TRATMENT
NO VACCINE
Both are experimental
Isolation precautions
Strict Infection control practices
Intensive supportive care (e.g. IVF, as patients are dehydrated).
SOME PATIENTS WILL RECOVER
WIT APPROPRIATE MEDICAL CARE
HOW CAN WE PREVENT SPREAD OF INFECTION?
IN COMMUNITY:
Orientation for people about the nature of
disease and transmission ways
Encouraging them to do hand hygiene when
visiting patients in hospitals or caring someone
at home
IN HOSPITALS
Standard precautions
Isolation precautions
Hand hygiene
Use of PPE:
1. Gowns
2. Gloves
3. Medical mask
4. Face covers (face shield / goggles)
Invasive procedures (high risk of exposure):
Strict procedure, with complete barriers
Patients died from infection should be handled
using appropriate PPE and buried immediately
WHAT IS WHO’S TRAVEL ADVICE DURING
OUTBREAKS?
Risk of infection for travelers is very low
Since transmission occurs by direct contact with blood, secretions or body fluids of infected persons.
Travel restrictions if necessary
Avoid any contact with infected patients
Travelers returning from affected areas should be aware of symptoms and seek medical advice
at first sign of illness
MOH GUIDELINES
Strict contact isolation precautions and using
proper PPE (Gloves, gown, mask and face covering)
Hand hygiene is essential
Dedicated medical equipment (preferably disposable), should be used of patient care
All non-dedicated, non-disposable equipment
should be disinfected in between patients
Procedures and lab testing should be limited to
the minimum necessary for essential diagnosis
and medical care
All needles and sharps should be handled with
extreme care and disposed immediately after use
MOH GUIDELINES (CONTINUED)
Environmental cleaning and disinfection safe
1. Use of the hospital environmental disinfectant is
enough
2. Handling of potentially contaminated
materials is highly important.
Housekeepers should use additional barriers
as shoe and leg coverings
3. Face protection by PPE should be used when
there is probability of splashing during waste
disposal
MOH GUIDELINES (Continued)
AEROSOL-GENARATION PROCEDURS
1. Conducted under airborne isolation
precautions
2. Using same PPE (as we do with MERS-CoV)
added to disposable shoe cover
3. Limiting the number of HCWs present during
the procedure to the essential needed
MOH GUIDELINES (CONTINUED)
Management of potentially exposed HCWs
1. Apply procedure of occupational exposure to
blood borne infection (needle prick or splashing
of blood or blood soiled secretions to the mucous
membrane of eyes, mouth or nose)
2. HCWs should receive follow up care for 21 days.\,
including fever checking twice daily.
3. Exposed HCW may continue work, while being
monitored.
MOH GUIDELINES (CONTINUED)
Visitors education
1. Visitors are not allowed to enter patient's room,
except for exceptional conditions that are essential
for patient’s wellbeing
2. Visitors should be screened for Ebola virus once they
arrive to the hospital
3. Visitors movement should be restricted to patient
care area
4. Visitors should be instructed about the natutre of
the disease
To summarize
1. Ebola virus disease is a severe, often fatal, illness
2. Death rate is up to 90%
3. Infection starts from contact with infected animals
then spreads from human to human.
4. Infected persons and dead bodies are the source of
infection
5. Infection occurs by direct contact with:
*Blood
*Secretions (stools, urine, saliva and semen)
*Body fluids
6. IP is 2-21 days and infectivity period begins
with start of symptoms (not during IP)
7. The patient becomes no more infectious based
on clinical and lab investigations
8. Typical symptms
Sudden onset of fever
Intensive weakness
Muscle pains
Headache
Sore throat
9. Followed by:
Vomiting
Diarrhea
Rash
Impaired kidney and liver functions
In some cases:
Bleeding (internal and external)
10. Confirmation (by lab investigations)
Deceased WBCs and platelets
Increased liver enzymes
Detecting the virus:
*Ag
*Ab
*PCR
*Culture
11. There is no specific treatment or vaccine
(experimental)
12. Prevention and conservative measures:
*Isolation precautions and use of PPE
*Strict infection control practices
* Intensive supportive care
THANKS
(Ebola hemorrhagic fever)
EPIDEMIOLOGY
It is a severe, often fatal, illness
It affects humans and nonhuman primates.
(e.g. fruit bats, monkeys and apes)
Death rate is up to 90%
First appeared in 1976 in two simultaneous outbreaks:
1. Congo (near Ebola river)
2. Sudan (in remote area)
Third outbreak occurred in the Philippines from
infected imported monkeys, in 1989.
Fourth outbreak is going in west Africa.
It started in Guinea, in March 2014 and has
spread to Liberia, Sierra Leone and Nigeria.
What is the causative organism?
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).
`
Ebola is a filamentous,
single-stranded RNA virus
How DOES INFECTIO START?
First infection occurs by Contact with blood, secretions and other body fluids of infected/dead animals
High risk animals are:
1. Fruit bats
2. Monkeys
3. Apes
Once a person comes in contact with infected
animal, it can spread within the community
from human to human
HOW DO PEOPLE BECOME INFECTED?
Infected persons/dead bodies are the sources of infection
Direct contact with
*Blood
* Secretions (stools, urine, saliva and semen)
* Body fluids
or contaminated items (clothes, linen, needles)
Route of entry through:
1. Non-intact skin
2. Mucous membrane
So infection spreads through:
1. Unsafe case management
2. Unsafe burial practices
Infectivity period
Incubation period: 2-21 days
Infectivity begins with start of symptoms
(not during IP)
Patients are infectious as long as they
contain the virus in their blood and sections
Infected patients should be monitored clinically and by lab investigations, to determine that they are no more infectious to others, before they return home
Men recovered from illness can still spread
the virus to their partners, through semen up to
7 weeks after recovery (sexual intercourse is
prohibited through this period).
Who is at risk of infection?
HCWs
Family members or others in close contact with
infected persons
Hunters in the rain forest who come on contact
with dead animals
Mourners who have direct contact with deceased bodies (as part of burial ceremonies)
More studies are needed to understand if some
groups are more susceptible than others to
Contacting the virus:
Immunocopromised
People with underlying conditions/diseases
What are the typical signs an symptoms?
Typical symptms
Sudden onset of fever
Intensive weakness
Muscle pains
Headache
Sore throat
Followed by:
Vomiting
Diarrhea
Rash
Impaired kidney and liver functions
In some cases:
Bleeding (internal and external)
Lab findings (confirmatory diagnosis):
Decreased WBCs
Decreased platelets
Increased liver enzymes
Antibody-capture enzyme-linked immunosorbent assay (ELISA)
Antigen detection tests
Serum neutralization testreverse transcriptase polymerase chain reaction (RT-PCR) assay
Virus isolation by cell culture
When should a person seek for
medical care?
Any person who:
Has been in an area known to have the disease
In contact with a person known or suspected
to have the disease
And , begins to have symptoms
should seek prompt medical care
What is the tratment?
NO SPECIFIC TRATMENT
NO VACCINE
Both are experimental
Isolation precautions
Strict Infection control practices
Intensive supportive care (e.g. IVF, as patients are dehydrated).
SOME PATIENTS WILL RECOVER
WIT APPROPRIATE MEDICAL CARE
HOW CAN WE PREVENT SPREAD OF INFECTION?
IN COMMUNITY:
Orientation for people about the nature of
disease and transmission ways
Encouraging them to do hand hygiene when
visiting patients in hospitals or caring someone
at home
IN HOSPITALS
Standard precautions
Isolation precautions
Hand hygiene
Use of PPE:
1. Gowns
2. Gloves
3. Medical mask
4. Face covers (face shield / goggles)
Invasive procedures (high risk of exposure):
Strict procedure, with complete barriers
Patients died from infection should be handled
using appropriate PPE and buried immediately
WHAT IS WHO’S TRAVEL ADVICE DURING
OUTBREAKS?
Risk of infection for travelers is very low
Since transmission occurs by direct contact with blood, secretions or body fluids of infected persons.
Travel restrictions if necessary
Avoid any contact with infected patients
Travelers returning from affected areas should be aware of symptoms and seek medical advice
at first sign of illness
MOH GUIDELINES
Strict contact isolation precautions and using
proper PPE (Gloves, gown, mask and face covering)
Hand hygiene is essential
Dedicated medical equipment (preferably disposable), should be used of patient care
All non-dedicated, non-disposable equipment
should be disinfected in between patients
Procedures and lab testing should be limited to
the minimum necessary for essential diagnosis
and medical care
All needles and sharps should be handled with
extreme care and disposed immediately after use
MOH GUIDELINES (CONTINUED)
Environmental cleaning and disinfection safe
1. Use of the hospital environmental disinfectant is
enough
2. Handling of potentially contaminated
materials is highly important.
Housekeepers should use additional barriers
as shoe and leg coverings
3. Face protection by PPE should be used when
there is probability of splashing during waste
disposal
MOH GUIDELINES (Continued)
AEROSOL-GENARATION PROCEDURS
1. Conducted under airborne isolation
precautions
2. Using same PPE (as we do with MERS-CoV)
added to disposable shoe cover
3. Limiting the number of HCWs present during
the procedure to the essential needed
MOH GUIDELINES (CONTINUED)
Management of potentially exposed HCWs
1. Apply procedure of occupational exposure to
blood borne infection (needle prick or splashing
of blood or blood soiled secretions to the mucous
membrane of eyes, mouth or nose)
2. HCWs should receive follow up care for 21 days.\,
including fever checking twice daily.
3. Exposed HCW may continue work, while being
monitored.
MOH GUIDELINES (CONTINUED)
Visitors education
1. Visitors are not allowed to enter patient's room,
except for exceptional conditions that are essential
for patient’s wellbeing
2. Visitors should be screened for Ebola virus once they
arrive to the hospital
3. Visitors movement should be restricted to patient
care area
4. Visitors should be instructed about the natutre of
the disease
To summarize
1. Ebola virus disease is a severe, often fatal, illness
2. Death rate is up to 90%
3. Infection starts from contact with infected animals
then spreads from human to human.
4. Infected persons and dead bodies are the source of
infection
5. Infection occurs by direct contact with:
*Blood
*Secretions (stools, urine, saliva and semen)
*Body fluids
6. IP is 2-21 days and infectivity period begins
with start of symptoms (not during IP)
7. The patient becomes no more infectious based
on clinical and lab investigations
8. Typical symptms
Sudden onset of fever
Intensive weakness
Muscle pains
Headache
Sore throat
9. Followed by:
Vomiting
Diarrhea
Rash
Impaired kidney and liver functions
In some cases:
Bleeding (internal and external)
10. Confirmation (by lab investigations)
Deceased WBCs and platelets
Increased liver enzymes
Detecting the virus:
*Ag
*Ab
*PCR
*Culture
11. There is no specific treatment or vaccine
(experimental)
12. Prevention and conservative measures:
*Isolation precautions and use of PPE
*Strict infection control practices
* Intensive supportive care
THANKS