ebola an update

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EBOLA A EMERGING THREAT Dr.T.V.Rao MD

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Ebola An Update

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Page 1: Ebola An Update

EBOLA A

EMERGING THREAT Dr.T.V.Rao MD

Page 2: Ebola An Update

Dr.T.V.Rao MD 2

Discovery of EBOLAEbola 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.

Page 3: Ebola An Update

Dr.T.V.Rao MD 3

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.

Page 4: Ebola An Update

Dr.T.V.Rao MD 4

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

Page 5: Ebola An Update

Dr.T.V.Rao MD 5

Filo virusFilo 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

Page 6: Ebola An Update

Dr.T.V.Rao MD 6

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.

Page 7: Ebola An Update

FRUIT BATS SPREAD THE INFECTION

Page 8: Ebola An Update

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

Page 9: Ebola An Update

Dr.T.V.Rao MD 9

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

Page 10: Ebola An Update

Dr.T.V.Rao MD 10

Events on EbolaEbola 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.

Page 11: Ebola An Update

Dr.T.V.Rao MD 11

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

Page 12: Ebola An Update

Dr.T.V.Rao MD 12

Spread of EBOLA

Page 13: Ebola An Update

Dr.T.V.Rao MD 13

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

Page 14: Ebola An Update

Dr.T.V.Rao MD 14

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.

Page 15: Ebola An Update

Dr.T.V.Rao MD 15

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

Page 16: Ebola An Update

Dr.T.V.Rao MD 16

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

Page 17: Ebola An Update

Progress of EBOLA

Page 18: Ebola An Update
Page 19: Ebola An Update

Mode of Spread

Page 20: Ebola An Update

Infected Patient a Concern to Health Workers

Page 21: Ebola An Update

Dr.T.V.Rao MD 21

Virus infect Several Organs

High titer of viruses are found in

Liver

Spleen,

Lungs

Kidneys

Blood

Other Body fluids

Page 22: Ebola An Update

SymptomsSymptoms 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.

Page 23: Ebola An Update

Dr.T.V.Rao MD 23

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.

Page 24: Ebola An Update

Dr.T.V.Rao MD 24

Serious manifestation of Ebola and Marburg

Internal and External

bleeding,

Shock,

Death

Page 25: Ebola An Update

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

Page 26: Ebola An Update

Laboratory testingChanges 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

Page 27: Ebola An Update

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.

Page 28: Ebola An Update

Dr.T.V.Rao MD 28

Diagnosis

Viruses are isolated from Blood by cell culture on Vero cells ( Vero –E 6 )

ELISA for antigen detection

ELISA for IgM

RT - PCR

Page 29: Ebola An Update

Infection controlThe 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

Page 30: Ebola An Update

Dr.T.V.Rao MD 30

Control of InfectionIsolation facilities within the Hospital remain the most important effective measure.

Barrier nursing remain the basic need in control of infection spread

Page 31: Ebola An Update

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.

Page 32: Ebola An Update
Page 33: Ebola An Update

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.

Page 34: Ebola An Update

Dr.T.V.Rao MD 34

The health care workers should

Avoid

Infected Blood,

secretions,

Tissues,

Wastes

Page 35: Ebola An Update

Dr.T.V.Rao MD 35

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.

Page 36: Ebola An Update

Dr.T.V.Rao MD 36

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".

Page 37: Ebola An Update

Dr.T.V.Rao MD 37

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.

Page 38: Ebola An Update

Dr.T.V.Rao MD 38

SIMPLE MEASURES CAN SAVE US

Page 39: Ebola An Update

HAND WASHING THE MOST IMPORTANT

Dr.T.V.Rao MD 39

Page 40: Ebola An Update

NEVER FORGET TO WEAR THE GLOVES AT EVERY STAGE WHEN WE COME IN CONTACT

WITH PATIETNS AND SCECRETIONS

Dr.T.V.Rao MD 40

Page 41: Ebola An Update

BE SCIENTIFIC IN APPROACH TO YOUR SUSPECTED

PATIENTS

Page 42: Ebola An Update

Dr.T.V.Rao MD 42

Learn and Practice the Biosafety as No infection is

Trivial to life

Page 43: Ebola An Update

Dr.T.V.Rao MD 43

FOLLOW BIOSAFETY AT EVERY STAGE OF WORK

Page 44: Ebola An Update

Dr.T.V.Rao MD 44

NEVER FORGET TO QURANTINE THE SUSPECTED

PATIETNS

Page 45: Ebola An Update

Dr.T.V.Rao MD 45

Barrier Nursing remains the only best option in

Prevention

Page 46: Ebola An Update

Dr.T.V.Rao MD 46

References and Resources

CDC on Ebola

WHO The current concepts on EBOLA

Google Images

Wikipedia resources on EBOLA

Page 47: Ebola An Update

Dr.T.V.Rao MD 47

Ebola is Greater Biohazard than we

Imagine

Page 48: Ebola An Update

Dr.T.V.Rao MD 48

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

Page 49: Ebola An Update

Dr.T.V.Rao MD 49

Created for Health awareness on EBOLA

Dr.T.V.Rao MD

Email

[email protected]