Professional Documents
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Outline
Ebola Virus
Epidemiology
Transmission
Environmental Persistence
Latest Situation Report
Highlights of the Ebola Crisis
Ebola Emergency Response
Crisis of Ebola-Contaminated Waste
Waste Treatment
Personal Comments
Ebola Filovirus
Ebola one of the most virulent pathogens
Family of Filoviridae
Five species
Zaire responsible for various outbreaks in Central Africa and
the current epidemic in West Africa (up to 90% case fatality
rate)
Sudan outbreaks in Sudan and Uganda in the 70s and 2000s
(50% case fatality rate)
Ta Forest (Ivory Coast) one human case (survived)
Bundibugyo emerged in Uganda in 2007 (30% case fatality
rate)
Reston found in monkeys and pigs in the Philippines, mild
or asymptomatic in humans
Pathogenesis
Ebola infects macrophages
Pathogenesis
Incubation period:
2 to 21 days (typically 2 - 6 days)
Symptoms:
Initial: Fever, fatigue, muscle pain, headaches
Nausea, diarrhea, vomiting, rashes
Symptoms of impaired kidney and liver function
Bleeding (in some percentage of patients): oozing from the
gums, blood in stool, etc.)
Lab findings:
Low WBC, platelet count
Elevated liver enzymes
Diagnosis
Travel and work history to determine possible
exposure
Most common diagnostic procedures in the field
Epidemiology
Filoviruses were first recognized in 1967
Ebola Zaire species first recognized in two outbreaks in Zaire
and Sudan in 1976 (Ebola is named after a river in Zaire)
Several hundred cases of ZEBOV in Kikwit, DRC, in 1995
ZEBOV first broke out in West Africa (Guinea) around
December 2013 and led to current epidemic
First case 2-year old child
Sustained human-to-human transmission to major cities of
Conakry, Guinea; Monrovia, Liberia; and Freetown, Sierra Leone
Transmission
Transmission
Viral reservoir believed to be fruit bats
Secondary hosts
Gorillas, chimpanzees
Antelopes
Pigs
Animal-to-human transmission
Contact with blood and other body fluids of infected animals
Food preparation of bush meat (contact with fluids, organs
and tissues of infected animals)
Transmission
Portals of entry
Mucous membranes,
conjunctiva,
pharynx
Skin breaks
Environmental Persistence
Laboratory studies:
99.99% reduction
5.9 days
No survivors
when tested at
14 days
Environmental Persistence
Laboratory studies:
Note: Cleaning & disinfection in the patient care environment increases protection.
Heat:
Ebola
is relatively fragile
Ebola
Boiling
Pressurized
Centers
Waste Treatment
Health impacts of burn barrels
Waste Treatment
Problems with the incinerators
Waste Treatment
Problems with the incinerators
and dibenzofurans
Family of 210 compounds
Among the most toxic compounds known to
humans
> The most toxic is
2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)
Environmental
9 to 15 years
Environmental half-life in subsurface
soil:
25 to 100 years
Volatilization half-life in a body of
water:
more than 50 years
IARC in 1997
Birth defects
Alteration in reproductive systems
Impact on childs learning ability and attention
Changes in sex ratio (fewer male births)
CONCLUSIONS REGARDING
ADVERSE HEALTH EFFECTS
REFERENCE
Residents living
within 10 km of an
incinerator, refinery,
and waste disposal site
P. Michelozzi et al.,
Occup. Environ. Med., 55,
611-615 (1998)
Residents living
around an incinerator
and other pollution
sources
CONCLUSIONS REGARDING
ADVERSE HEALTH EFFECTS
REFERENCE
122 workers at an
industrial incinerator
T. Drummer, H. Dickinson
and L. Parker, Journal of
Epidemiological and
Community Health, 57,
456-461 (2003)
600
554
Canada
Germany
MWIs
400
200
0
0
1984
2002
200
MWIs
On-Site MWIs
United States
Portugal
50
40
30
20
10
0
40
1
1995
Ireland
150
150
100
50
0
1990s
2005
2004
Waste Treatment
Ebola is destroyed by autoclaving in seconds
Technology built by Africans for Africa
No smoke, no dioxins nor HCl, no toxic air pollutants
Safe for workers with PPE
Special barrel trolley protects workers from Ebola exposure
Uses mechanical controls instead of computer controls
easier to fix
Rides through power outages that are common in Africa
Uses steam ejectors instead of vacuum pumps less
maintenance problems, waste volume reduced by 40-60%
Installs in one day, cheaper than an incinerator
Exceeded international standards by an order of magnitude
Personal Comments
Personal Comments
Personal Comments
Personal Comments
Ebola cases are beginning to decrease in West
Africa
Work is now shifting towards recovery