Global Scenario on Ebola Virus

What is Ebola
 Ebola is a virus that lives in bats and some other animals who
live in Africa.
 People can get Ebola in West Africa by preparing these sick
animals for food.
 People can spread the virus to other people when they are
very sick. This is the main way that people are now getting
Ebola in West Africa.
 Ebola virus disease (EVD), also known as Ebola
hemorrhagic fever (EHF) or simply Ebola, is a 
viral hemorrhagic fever of humans and other primates caused
by ebolaviruses.
Named because of Ebola River
First appearance of Ebola Virus Disease

 In Sudan and Zaire in 1976 FIRST OUTBREAK

 In Sudan Infected over 284 people
 Killing 53% of victim
 Another strain appeared
 Infected another 318 people
 Mortality rate was 86%
 3rd STRAIN
 Known as Reston, Virginia
 From the Philippines
 Virus infected some, but patients didn’t develop Ebola
virus haemorrhagic fever.
 4th INFECTION OF EVD

In 1994 When a female ethnologist was performing a

necropsy on dead chimpanzee
she infected herself while performing necropsy
AFFECT OF EBOLA VIRUS 1976-2014
 Recent Cases of Ebola Virus
 August 26, 2014 in DRC
 Pregnant woman from Ikanamogo village butchered a
bush animal
 And became ill with symptoms of EVD
 Reported to private clinic in Isaka village
 Died on 11 August
 Continued…

With death meant,

 several healthcare workers were
exposed to Ebola virus
 Total cases = 24
 Death cases = 13
 Human to human transmission has been
established
 SEPTEMBER 6, 2014
31 more cases of Ebola reported DRC
Increases to 62
Total no. of deaths reported to 35

SEPTEMBER 21,2014
There have 68 cases of Ebola Virus reported in DCR
Death cases = 41
Outbreak is unrelated to the current outbreak of
Ebola in West Africa

SEPTEMBER 24, 2014

70 cases reported in DRC
Death cases = 42
OCTOBER 5, 2014
70 cases
Death cases = 43

OCTOBER 12, 2014

Total cases = 8997
Laboratory confirmed cases = 5006
Total deaths = 4993

OCTOBER 14 ,2014
On the morning, second healthcare worker reported
to hospital
With low grade fever CDC confirmed-This worker who tested
positive last night travelled by air on October 13
COUNTRIES AFFECTED WITH
EVD
RECENTLY AFFECTED COUNTRIES
 Congo
 Nigeria
 Senegal
 Liberia
 Guinea
 Sierra Leone
 Spain
 USA
2019 update ( up to 9th December)

 In The Democratic Republic of the Congo

 Total Cases 3324
 Total death 2206
 Survivors 1084
 Bangladesh scenario

 The recent outbreak affecting several nations also alarmed the public
health sector of Bangladesh. But virus and healthcare experts have
assured that there is nothing to be anxious about Ebola in Bangladesh
as it has been categorized as among the least threatened countries by
the World Health Organization (WHO) on August 8, 2014 in its first
Emergency Committee meeting. Bangladesh Government has already
taken effective preventive measures suggested by WHO, which include
careful screening of the people coming back home from Ebola affected
countries and also giving adequate safety training on the threat of
Ebola exposure to the people going to those countries.
 Continued…

 It is a matter of relief and contentment that the Institute of

Epidemiology, Disease Control and Research (IEDCR)
laboratory of Bangladesh has the capacity to primarily
identify an Ebola patient but the identified samples need to
be sent to the US Centers for Disease Control and
Prevention (CDC) headquarters in Atlanta for a confirmed
result which could take a couple of days. Moreover the
WHO has promised all necessary technical support to
Bangladesh and requested the government to increase
vigilance and screening at ports.
Continued…
 As part of an ongoing countrywide 90 day Ebola alert from
October 2014, screening centers and health desks have
been set up at 25 ports, including three international
airports and two seaports of the country. Health directorate
officials said 15 isolation wards at district hospitals near the
ports have been kept ready to provide treatment if any
suspected Ebola patient was found. A 20 bed specialized
ward is also set to be opened soon at the Kurmitola
General Hospital in Dhaka. Officials said 3,167 personnel -
doctors, nurses and sanitary inspectors who work at the
health desks at the ports - have been provided specialized
training on Ebola detection, management and handling.
 Virology

 Ebola virus is an infectious which kills in a short time.

 Needs a host cell to survive.
 Considered like a non living entity.
 Which is severe, often fatal disease caused by infection
with a species of Ebola virus.
 Virus classification

 Genus Ebola virus is 1 of 3 members of the Filoviridae

family (filovirus)
 Along wit genus Marburg virus and genus Cueva virus.
 Group: Group V (-) ssRNA
 Order: Mononegavirales
 Family: Filoviridae
 Genus: Ebolavirus
 Species
 Genus Ebolavirus comprises 5 distinct species:
 Bundibugyo ebolavirus (BDOV)
 Zaire ebolavirus (EBOV) Outbreaks of AFRICA
 Sudan ebolavirus (SUDV)
 Reston ebolavirus (RESTV)
 Tai Forest ebolavirus (TAFV).

 BDBV, EBOV & SUDV have been associated with large EVD outbreaks in
Africa, whereas RESTV & TAFV have not.
 The RESTV species found in Philippines & People’s Republic of China,
can infect humans but no illness or death in humans from this species has
been reported to date.
 Continued…

 The Zaire ebolavirus is the most dangerous of the five

species of Ebola viruses of the Ebolavirus genus which are
the causative agents of Ebola virus disease.
 The virus causes an extremely severe hemorrhagic fever in
humans & other primate.
 The name Zaire ebolavirus is derived from Zaire, the
country ( now the Democratic Republic of Congo) in which
the Ebola virus was first discovered & the taxonomic suffix
ebola virus (which denotes an Ebola virus species).
Structure
 Continued…
 The EBOV genome is approximately 19 kb in length. It
encodes seven structural proteins:
 Nucleoprotein (NP)
 Polymerase cofactor (VP35), (VP40)
 GP
 Transcription activator (VP30), (VP24)
 RNA polymerase (L)
 Continued…
 The tubular Ebola virions are generally 80 nm in diameter and 800 nm
long. In the center of the particle is the viral nucleocapsid which
consists of the helical ssRNA genome wrapped about the NP,
VP35,VP30 and L proteins
 This structure is then surrounded by an outer viral envelope derived
from the host cell membrane that is studded with 10 nm long viral
glycoprotein (Gp) spikes. Between the capsid and envelope are viral
proteins VP40 and VP24.
 This envelope GP spike is expressed at the cell surface & is
incorporated into the virion to drive viral attachment & membrane
fusion.
 It has also been shown as the crucial factor for Ebola virus pathogenicity.
 GP is actually post-translationally cleaved by the proprotein convertase furin to
yield disulphide-linked GP1 GP2 subunits.
 GP1 allows for attachment to host cells, while GP2 mediates fusion of viral &
host membranes.
 This protein assembles as a trimer of heterodimers on the viral envelope &
ultimately undergoes an irreversible conformation change to merge the two
membranes.
 Pathophysiology

 Endothelial cells, mononuclear phagocytes & hepato cytes are the main
targets of infection. After infection, a secreted glycoprotein (sGP)
known as the Ebola virus glycoprotein (GP) is synthesized.
 Ebola replication overwhelms protein synthesis of infected cells & host
immune defenses.
 The GP forms a trimeric complex, which binds the virus to the
endothelial cells lining the interior surface of blood vessels. The sGP
forms a dimeric protein that interferes with the signaling of neutrophils,
a type of white blood cell, which allows the virus to evade the immune
system by inhabiting early steps of neutrophil activation.
 These white blood cells also serve as carriers to transport the virus
throughout the entire body to places such as the lymph nodes, liver,
lungs & spleen.
 Transmission

 Direct contact with infected patients or cadavers

 Mucosal surfaces, skin abrasions, parenteral introduction
 Blood, vomit, excreta, genital and nasal secretions, sweat,
urine
 Pathogenesis

 Every tissue is affected except bones & muscles.

 The virus creates blood clots.
 Clots goes towards internal organs (lungs, eyeball).
 It prevents oxygen to rise tissue.
 The virus also destroys connective tissue (affinity with
collagen.
 Symptoms
 Initial symptoms:
 High temperature (at least
38.8° C)
 Muscle, joints, abdominal pain
 Nausea
 Blood stream slow down
 Loss of appetite
 Rashes
 Increased liver enzyme activity
 Late symptoms
 Vomiting
 Diarrhoea
 Coughing
 Pharyngitis
 Prostation
 Severe vomiting of blood
 Haemorrhage
 Internal & external haemorrhage
from orifices (nose mouth skin,
eyes)
 Low white blood cell count
 Laboratory Diagnosis
 Ebola virus infections can be diagnosed in a laboratory
through several types of tests:
 Antibody-capture enzyme-linked immunosorbent
assay (ELISA) -NP is one of the major viral structural
components
 Antigen detection tests
 Serum neutralization test
 Reverse transcriptase polymerase chain reaction (RTPCR)
assay
 Electron microscopy
 Virus isolation by cell culture
 Continued…
 Samples from patients are an extreme biohazard risk;
testing should be conducted under maximum
biological containment conditions.
 CDC diagnosis
 Timeline of Infection
 Within a few days after
symptoms begin
 Later in disease course or
after recovery
 Retrospectively in
deceased patients
 Diagnostic tests available
 Antigen-capture enzyme-linked
immunosorbent assay (ELISA) testing
•IgM ELISA
•Polymerase chain reaction (PCR)
•Virus isolation
 IgM and IgG antibodies
 •Immunohistochemistry testing
•PCR
•Virus isolation
 When Specimens Should Be
Collected for Ebola Testing

 Ebola virus is detected in blood only after onset of

symptoms, most notably fever.
 It may take up to 3 days post-onset of symptoms for
the virus to reach detectable levels.
 Virus is generally detectable by real-time RT-PCR
from 3-10 days post-onset of symptoms, but has been
detected for several months in certain secretions.
 Specimens ideally should be taken when a
symptomatic patient reports to a healthcare facility
and is suspected of having an EVD exposure.
 However, if the onset of symptoms is <3 days, a
subsequent specimen will be required to completely
rule-out EVD
 From whom the samples are to be
collected?

 The samples should be collected from any person ill or

deceased who has or had fever with acute clinical
symptoms and signs of hemorrhage, such as bleeding
of the gums, nose-bleeds, conjunctival injection, red
spots on the body, bloody stools and/or melaena
(black liquid stools), or vomiting blood (haematemesis) with the history of travel
to the affected area.

 Or any person (living or dead) having had contact with a

clinical case of EBVD and with a history of acute fever.
 Anyone who has accidently come in contact with
blood or body fluids should be kept under quarantine
and observed for 30 days.
 Preferred Specimens for Ebola Testing

 A minimum volume of 4mL whole blood / serum/

plasma preserved with EDTA, clot activator, sodium
polyanethol sulfonate (SPS), or citrate
in plastic collection tubes can be submitted for EVD
testing.
 Postmortem: Tissue sample (liver, spleen, bone
marrow, kidney, lung and brain)
 Do not submit specimens preserved in heparin tubes.
 Specimens should be stored at 4°C or frozen.
 Before dispatching the sample disinfect the outer
surface of container using 1:100 dilution of bleach or
5% Lysol solution.
 Transporting Specimens within the Hospital
/Institution

 Specimens should be placed in a durable, leak-proof

secondary container for transport within a facility.
 To reduce the risk of breakage or leaks, do not use any
pneumatic tube system for transporting suspected
EVD specimens.
 Treatment
 There are no licensed specific treatment.
 Patients are Frequently dehydrated and requires oral
 Rehydration with solution containing electrolyte.
 New drug therapies are being evaluated.
 However there have been very recent development
in preventative medication.
 Recommended care includes:
 Volume repletion
 Maintenance of blood pressure (with vasopressors if needed)
 Maintenance of oxygenation Pain control
 Nutritional support
 Treating secondary bacterial infections and preexisting comorbidities
A hospital isolation ward in Gulu, Uganda, during
the October 2000 outbreak
 Prognosis
 a high fatality rate for this disorder (80% to 90%)
 mortality from Ebola has ranged from 25% to 90% and
recovery is
slow in those who survive.
 Morbidity and mortality rates are very high, and they vary
with the
strain of Ebola
 The most highly lethal Ebola subtype is EBO-Z, which has
been reported to have a mortality rate as high as 88%.
 The EBO-S subtype has a reported mortality rate of 50%,
similar to that of the Ebola outbreak in Gabon, where the
mortality rate was 57-66%.
 Vaccine:
 No vaccine is currently available for humans.
 The most promising candidates are DNA vaccines or
vaccines
derived from adenoviruses, vesicular stomatitis Indian virus
(VSIV) or filovirus-like particles (VLPs)because these
candidates could protect nonhuman primates from
ebolavirus-induced disease. DNA vaccines, adenovirus-
based
vaccines, and VSIV-based vaccines have entered clinical
trials.
 Vaccines have protected nonhuman primates.
Prevention
  Prevention focuses on avoiding contact with
the viruses. The following precautions can
help prevent infection and spread of Ebola
 Avoid areas of known outbreaks.
 Wash your hands frequently. As with other infectious
diseases, one of the most important preventive measures is frequent
hand-washing. Use soap and water, or use alcohol-based hand rubs
containing at least 60 percent alcohol when soap and water aren't
available.
 Continued…
 Avoid wildlife /bush meat. In developing countries, avoid buying or eating the wild
animals,
including nonhuman primates, sold in local markets.
 Avoid contact with infected people. In particular, caregivers should avoid contact
with the
person's body fluids and tissues, including blood, semen, vaginal secretions and
saliva.
People with Ebola are most contagious in the later stages of the disease.
 Follow infection-control procedures. If you're a health care worker, wear
protective clothing, such as gloves, masks, gowns and eye shields. Keep infected
people isolated from others. Dispose of needles and sterilize other instruments.
 Don't handle remains. The bodies of people who have died of Ebola disease are
still contagious. Specially organized and trained teams should bury the remains,
using appropriate safety equipment
 Infection Control for Collecting and
Handling Specimens

 This includes wearing appropriate personal protective

equipment (PPE) and adhering to engineered safeguards,
for all specimens regardless of whether they are identified
as being infectious.
 Recommendations for specimen collection: full face
shield or goggles, masks to cover all of nose and mouth,
gloves, fluid resistant or impermeable gowns. Additional
PPE may be required in certain situations.
 Recommendations for laboratory
testing
 full face shield or goggles
 masks to cover all of nose and mouth
 Gloves
 fluid resistant or impermeable gowns
 use of a certified class II Biosafety cabinet or plexiglass
splash guard
 disinfectants routinely used to decontaminate the
laboratory environment (benchtops and surfaces) and
the laboratory instrumentation are sufficient to
inactivate enveloped viruses, such as influenza,
hepatitis C, and Ebola viruses.
 PATIENT PLACEMENT

 Place the patient in Single room (containing a private

bathroom) with the door closed.
 Maintain a log of persons entering the patient’s room.
 Allow access to only those necessary for the patient’s wellbeing and
care, such as a child’s parent.
 Use of Personal Protective Equipment is essential. All persons
entering the patient room should wear at least:
 Gloves
 Gown (fluid resistant or impermeable)to cover
 clothing and exposed skin
 Eye protection (goggles) to prevent splashes on eye.
 Facemask to prevent splashes on nose and mouth.
 Face shield, if used, will protect eye, nose and mouth.
 Closed shoes
Waste management
  Waste should be segregated to enable appropriate and safe handling.
 Sharp objects (e.g. needles, syringes, glass articles) and
tubing that has been in contact with the bloodstream
should be placed inside puncture resistant containers.
 These should be located as close as practical to the area in
which the items are used.
 Collect all solid, non-sharp, medical waste using leak-proof
waste bags and covered bins.
 Waste should be placed in a designated pit of appropriate depth (e.g. 2 m deep and
filled to a depth of 1–1.5 m). After each waste load the waste should be covered
with a layer of soil 10–15 cm deep.
 Placenta and anatomical samples should be buried in a separate pit or incinerated
 An incinerator may be used to destroy solid waste. However,
it is essential to ensure that total incineration has taken
place.
 The area designated for the final treatment and disposal of
waste should have controlled access to prevent entry by
animals, untrained personnel or children. Waste, such as faeces,
urine and vomit, and liquid waste from washing, can be disposed
of in the sanitary sewer or pit latrine. No further treatment is
necessary.
 Wear gloves, gown, closed shoes and goggles/facial protection,
when handling liquid infectious waste(e.g. any secretion or
excretion with visible blood even if it originated from a normally
sterile body cavity). Avoid splashing when disposing of liquid
infectious waste
 Waste, such as faeces, urine and vomit, and liquid
waste from washing, can be disposed of in the
sanitary sewer or pit latrine. No further treatment
is necessary.
 Wear gloves, gown, closed shoes and goggles/facial
protection, when handling liquid infectious waste
(e.g. any secretion or excretion with visible blood
even if it originated from a normally sterile body
cavity). Avoid splashing when disposing of liquid
infectious waste
 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 be infected.
 In the United States the law allows quarantine of those
infected with Ebola.
 The lack of roads and transportation may help slow the
disease in Africa.
 During the 2014 outbreak Liberia closed schools.
 Bioterrorism

 Locality of this virus has become less isolated as the

threat of bioterrorism looms large.
 The Ebola virus is now on the “A” list for hopeful
vaccination development.
 Experiments have even been formed to show how
Ebola can be used as a bioterror agent.
Response to An Epidemic…
 PATIENT
 Isolation & treatment
 CONTACTS
 List and follow-up
 HEALTH CARE WORKERS
 Protection, training
 POPULATION
 Information, prevention
 POLICY MAKERS
 Surveillance
 Multi-sectoral collaboration
 Clear guidelines and measures
correctes
 Coordination 60

 Centralised communication
 Conclusion
 Ebola virus is extremely virulent.
 The infected organism does not have time to
react to the virus.
 First symptoms appear during the critical
period.
 Even though scientists have recently made
breakthroughs there is still need for extensive research
to find vaccines and cures for this deadly virus
Thank you