Sara Khan

and
Sama Hadous

EBOLA
Definition:
1. Ebola is a severe, often-fatal disease in
humans and nonhuman primates (monkeys,
gorillas, and chimpanzees) that has appeared
sporadically since its initial recognition in
1976.
2. Ebolas symptoms are often an onset of fever,
weakness, muscle pain, headache and sore
throat. This is followed by vomiting, diarrhea,
rash, limited kidney and liver functions, and
both internal and external bleeding. Patients
are frequently dehydrated and in need of
intravenous fluids.

Filoviridae
Ebola
Ebola-Zaire
Ebola-Sudan
Ebola-Reston

There are 3 major types of
Ebola, each named for
the place where the
outbreak occured
Taxonomy and Classification
The first cases of the Ebola virus disease were seen in 1976 in southern
Sudan and northern Zaire, located 500 miles apart from each other. More
cases occurred in Zaire in 1977 and in Sudan in 1979.
THE CULPRIT
The virus was mostly dormant after the initial outbreaks --
however, in 1989, a subtype of the virus caused a scare in Reston,
Virginia, when four laboratory workers became infected from
cynomolgus monkeys imported from the Philippines.

Nearly twenty years later, in may 1995, a deadly
outbreak appeared in Zaire.
Although the source of the outbreak is not quite
known even today, it is suspected that the
outbreak began when a laboratory worker became
infected from a monkey.

Just as the outbreak in Zaire was beginning to
subside, the world health organization (WHO)
reported 20 cases of Ebola in Gabon (west Africa),
sparking new concerns about the disease.

The Natural History of Ebola Itself Is Still a Mystery --
No One Knows Where the Virus Lays Dormant Between
Epidemics or How It Maintains Its Survival in Nature.
Although the Reston
outbreak suggested
that the cynomolgus
monkeys could be a
reservoir, there are
several other
possible reserviors,
such as other
monkeys, bats, and
insects.

The natural reservoir of the Ebola virus seems to reside in the
rain forests of Africa and Asia, but has not yet been identified.

Different hypotheses have been developed to try
to explain the origin of Ebola outbreaks.
Initially, rodents were suspected, as is the case
with Lassa fever whose reservoir is a wild rodent
(Mastomys).

Another hypothesis is that a plant virus may have
caused the infection of vertebrates.
Laboratory Observation Has Shown That Bats Experimentally Infected
With Ebola Do Not Die and This Has Raised Speculation That These
Mammals May Play a Role in Maintaining the Virus in the Tropical Forest.
Although this hypothesis is still being tested, and has not yet been
confirmed.

Although non-
human primates
have been the
source of
infection for
humans, they are
not thought to
be the reservoir.
They, like
humans, are
infected directly
from the natural
reservoir or
through a chain
of transmission
from the natural
reservoir.
Extensive Ecological Studies Are Currently Under
Way in Cte d'Ivoire to Identify the Reservoir of
Ebola. Studies to Identify the Reservoir of Marburg
Virus, a Closely Related filovirus Are Being
Conducted in the Democratic Republic of the Congo.


He opens his mouth and gasps into the
bag, and the vomiting goes on
endlessly. It will not stop, and he keeps
bringing up liquid, long after his stomach
should have been empty. The airsickness
bag fills up to the brim with a substance
known as vomito negro, or the black
vomit. The black vomit is not really black;
it is speckled liquid of two colors, black
and red, a stew of tarry granules mixed
with fresh red arterial blood. It is
hemorrhage, and it smells like a
slaughterhouse. The black vomit is loaded
with virus. It is highly infective, lethally
hot, a liquid that would scare the daylights
out of any military biohazard specialist.
- excerpt from THE HOT ZONE by Richard
Preston-
Effects of Ebola on the
Human Body

Ebola Zaire attacks every organ and tissue in the
human body except skeletal muscle and bone.

It is a parasite that transforms virtually every
part of the body into a digested slime of virus
particles.

The seven mysterious proteins that, assembled
together, make up the Ebola-virus particle, work
as a relentless machine, a molecular shark, and
they consume the body as the virus makes copies of
itself. Small blood clots begin to appear in the
bloodstream, and the blood thickens and slows, and
clots begin to stick to the walls of blood vessels.
This is known as pavementing, because
the clots fit together in a mosaic.
The mosaic thickens and throws more
clots, and the clots drift through the
blodstream into the small capillaries,
where they get stuck.

Maculopapular Rash
Ebola attacks
connective tissue
with particular
ferocity; it
multiplies in
collagen, the chief
constituent protein
of the tissue that
holds the organs
together. (The seven
Ebola proteins
somehow chew up the
body's structural
proteins.) In this way,
collagen in the body
turns to mush, and the
under layers of the
skin die and liquefy.


This shuts off the blood supply to various
parts of the body, causing dead spots to
appear in the brain, liver, kidneys, lungs,
intestines, testicles, breast tissue (of
men as well as women), and all through
the skin.
The skin develops red spots, called
petechiae, which are hemorrhages under
the skin.

The skin bubbles up into a sea of tiny
white blisters mixed with red spots known
as a maculopapular rash.
The red spots on the skin grow and spread
and merge to become huge, spontaneous
bruises, and the skin goes soft and pulpy,
and can tear off if it is touched with any
kind of pressure.

Rash in Dengue HF
(blanches with pressure)

Your mouth bleeds, and you bleed around your
teeth, and you may have hemorrhages from the
salivary glands -- literally every opening in the
body bleeds, no matter how small.









The back of the throat and the lining of the
wind pipe may also slough off, and the dead
tissue slides down the windpipe into the lungs or
is coughed up with sputum.

The surface if the
tongue turns brilliant
red and the sloughs off,
and is swallowed or spat
out. It is said to be
extraordinarily painful
to lose the surface of
one's tongue. The
tongue's skin may be torn
off during rushes of the
black vomit.

Your heart bleeds into
itself; the heart muscle
softens and has
hemorrhages into its
chambers, and blood
squeezes out of the
heart muscle as the
heart beats, and it
floods the chest cavity.


The brain becomes clogged
with dead blood cells, a
conditions known as sludging
of the brain.

Droplets of blood stand out on the eyelids:
you may weep blood. The blood runs from
your eyes down your cheeks and refuses to
coagulate.

Ebola attacks the lining of
the eyeball, and the eyeballs
may fill up with blood: you
may go blind.

You may have a hemispherical stroke, in which
one whole side of the body is paralyzed, which is
invariably fatal in a case of Ebola.

Even while the body's internal organs are
becoming plugged with coagulated blood, the
blood that streams out of the body cannot clot;

The blood has been stripped of its clotting
factors.

If you put the runny Ebola blood in a test tube
and look at it, you see that the blood is
destroyed. Its red cells are broken and dead.

The Spreading of Ebola

The Ebola virus is transmitted by direct contact with the blood,
secretions, organs or semen of infected persons.

As the primary mode of person-to-person transmission is
contact with contaminated blood, secretions or body fluids,
any person who has had close physical contact with patients
should be kept under strict surveillance.
Transmission of the Ebola virus has also occurred by
handling ill or dead infected chimpanzees, as was
documented in Cte d'Ivoire and Gabon.
Health care workers have frequently been infected while
attending patients.
In the 1976 epidemic in Zaire, every Ebola case
caused by contaminated syringes and needles died.

EBOLA VACCINE
Recent Discoveries
Although many hypothesis exist, no one has
worked out yet which animal is the 'reservoir' for
Ebola virus, meaning the animal that is hosting
it and occasionally transmitting it to humans. So
it is currently impossible to control the
expansion of the virus. Therefore making a
vaccine is essential.
Recently there has been a breakthrough in the war against
Ebola. Scientists have created a vaccine that protects monkeys
from being infected by the deadly virus.
Tests were performed, and with the new vaccine,
many monkeys survived the Ebola virus.
Testing of a potential Ebola vaccine began mid
November of 2003 directed Dr. Anthony Fauci, Dr.
Gary Nobel and researchers at San-Diego based
Vical Inc This finding is the result of a
collaboration between scientists at the Dale and
Betty Bumpers Vaccine Research Center (VRC), the
National Institute of Allergy and Infectious
Diseases (NIAID), and scientists at the United States
Army Medical Research Institute of Infectious
Diseases (USAMRIID) at Fort Derrick in Maryland.
The vaccine has so far fully protected monkeys from
the virus and vaccine results in monkeys usually
translate well in humans.
The vaccine uses pieces of DNA from the virus to
prime the immune system. The vaccine is
synthesized using modified, inactivated genes
from the Ebola virus. It does not contain
infectious material from the virus so the
recipients cannot get Ebola. Researchers plan on
testing 27 volunteers of ages 18-44. This is a
three-stage process- the first stage involving
testing the safety of the vaccine. The US National
institute of Allergy and Infectious diseases will
test the vaccine for safety. During the trial 27
volunteers will receive injections over two
months and will be observed for a year.
The first injection would first be given to prime
the immune system. The second injection uses an
adenovirus, which causes colds, to boost the
immune system that has been primed by the Vical
vaccine. The goal is to use the Vical vaccine and
another to boost-prime the immune system to
protect against Ebola. This study has previously
been carried out successfully on guinea pigs and
monkeys. In both species they found 100%
protection. Terrifying outbreaks of Ebola have
been occurring regularly in Africa and since the
vaccine seems to work pretty quickly it may be
pressed to test the vaccine in an outbreak of Ebola
under emergency conditions to control epidemics.

Questions??
These are a couple of quick questions
that one might ask when first hearing
about Ebola.
What is Ebola?
Ebola is a filovirus named after a river in
Zaire, its first site of discovery. This filovirus
is usually fatal, and it affects monkeys, apes
and humans. Filoviruses are string-shaped,
with a little hook or loop at one end. Another
filovirus is the Marbug virus, which gives
similar symptoms to Ebola, but the chance
of surving an infection of Marbug virus is
higher.

What strains Exist??
As of 6-06-1998, there have been four identified:
Ebola Zaire - The virus discovered in Zaire in 1976 - the first known
occurrence of the Ebola Virus.

Ebola Sudan - Initially discovered in western Sudan in 1976. This
type of Ebola virus resurfaced again in 1979 in Sudan.

Ebola Reston - This is the variation of the Ebola virus discovered in
the African monkeys imported to the United States. This particular
type is not believed to cause health problems in Humans.

Ebola Tai - This is the most recently discovered type of the Ebola
virus. Discovered in 1995 on the Ivory Coast of West Africa, in the
Tai Forest. A Swiss researcher was the first infected human, but
survived the infection.
* A fifth type of Filovirus named Marbug also exists, and shows very
similar signs to Ebola, but is not a strain of Ebola. *

How do the strains differ?
Ebolas Zaire, Sudan, and Tai cause illness in
humans as well as primates (monkeys). Ebola
Reston does not cause illness in humans, but does
cause illness in monkeys. Ebola Reston is
suspected to be airborne (transmitted by the air)
where the other strains are not transmitted by air.
As for their structure, they are all quite similar in
(string-like) shape, but have different gene
sequences in places, and therefore different
properties.

What are the symptoms?
All forms of viral hemorrhagic fever begin with fever and muscle
aches. Depending on the particular virus, disease can progress until
the patient becomes very ill with respiratory problems, severe
bleeding, kidney problems, and shock. With Ebola, persons develop
fever, chills, headaches, muscle aches, and loss of appetite. As the
disease progresses, vomiting, bloody diarrhea, abdominal pain, sore
throat, and chest pain can occur. The blood fails to clot and patients
bleed from injection sites as well as into the gastrointestinal tract,
skin, and internal organs. Basically, you just bleed from every
orifice.
Ebola Zaire seems to be fatal in about 90% of the cases. Ebola
Sudan is fatal in about 60%. We can't really determine a fatality rate
in humans for the recently discovered Ebola Tai strain. There has
only been one case, and the Swiss researcher who contracted it from
a chimpanzee in the Tai forest was critically ill, but she survived
(probably due to the intensive care she received in Switzerland).
Ebola Reston is not known to be fatal to humans, but very fatal to
monkeys.

How long can you contract ebola before you start showing
symptoms?
Anywhere from 2 to 21 days, although 7-14 days is the most
common interval.
How does Ebola effect your body?
Ebola interacts specifically with liver cells and cells of the
reticuloendothelial system. The lining of blood capillaries are
attacked (either directly by the virus or by the cytokine
cascade secondary to infection of macrophages). The
capillaries start to leak fluids and plasma proteins. Some
patients experience intravascular coagulation, and
subsequent loss of normal clotting capability. This eventually
leads to shock because of low water volume in the body. This
also causes a general interruption of tissue oxygenation
causing critical organ failure. Clinical shock, once present, is
usually impossible to reverse.

How is ebola transmitted?
The Ebola virus is spread through close personal contact with
a person who is infected with Ebola. Often, infection (in
previous outbreaks) have occurred among hospital care
workers or family members who were caring for an ill or dead
person infected with Ebola virus. Blood and body fluids
contain large amounts of virus, thus transmission of the virus
has also occurred as a result of hypodermic needles being
reused in the treatment of patients. Reusing needles is not an
uncommon practice in developing countries, such as Zaire,
Gabon, and Sudan, where the health care system is
signficantly underfinanced.
What do you do with a dead body?
If the patient dies, his or her corpse
remains VERY infectious and must be
handled with extreme caution, and
disposed of properly. It is a serious
hazard to have around.
Can a survivor transmit Ebola to others after she or he has fully
recovered?
Patients who have completely recovered from an
illness caused by Ebola virus do not pose a serious
risk for spreading the infection. However, the virus
may be present in the genital secretions of such
persons for a period (up to 7 weeks) after their
recovery, and therefore it is possible they can
spread the virus through sexual contact.
Is Ebola airborne?
There is no confirmed evidence of airborne transmission of
Ebola Sudan, Ebola Zaire, or Ebola Tai between humans.
There have been no clinically proven cases of airborne
transmission between monkeys; however there was a recent
report in ProMED that two control monkeys caged across the
room from monkeys infected with Ebola Zaire died of Ebola
Zaire. It appears that the Ebola virus might have been spread
to the control monkies by an aerosol produced by someone
cleaning the infected monkeys cage with a hose. It is
hypothesised that the Ebola virus became "airborne" by being
caught inside small droplets of water that the control monkeys
eventually breathed. Further study is needed to clarify this.

The Reston strain appears to have been transmittable by
airborne means, but that particular strain is not known to be
harmful to humans.
What is the host?
One of the keys to try to find a cure or vaccine for Ebola is to
discover its' natural host. Although extensive research has
been done, scientist have no evidence of the natural host of
Ebola. Many people are under the misconception that
monkeys are the natural host for Ebola. This is highly unlikely
since monkeys die of Ebola as quickly as humans. A disease
'looks' for a host that can transmit it as much as possible. If a
host dies off of the disease in a few days, that isn't much help
to the disease.
What is the name of the infectious agent (the microbe)?
It's simply called the Ebola virus. It's in the Filovirus family,
which has five known members: Marburg, Ebola Zaire, Ebola
Sudan, Ebola Reston, and Ebola Tai; genus Filoviridae.
conclusion
In conclusion the Ebola virus kills about 90% of its victims,
and and the vaccine recently discovered are for the primates.
These are soon going to be tested on humans, but it would be
difficult to find a group of humans that would volunteer to be in
the experiments. Currently the plan is to put the vaccine to
the test, as soon as a new outbreak occurs.
The end