Ebola Update October 24, 2014

Dr. Gayane Hovhannisyan

Associate Medical Officer of Health

Outline

• Overview: Ebola virus disease;

• Ebola outbreak in West Africa, Congo

and the US;

• Update from Public Health Agency of

Canada;

• Update from the MOHLTC

• Public Health Ontario: screening tools,

best practice guidelines

Ebola Virus Characteristics

• RNA virus (enveloped)

• Reservoir- fruit bats in

tropical rainforest;

• Highly infectious during

later stages of the

disease;

• Humans and non-human

primates can get infected.

Photo Credit: CDC/Cynthia Goldsmith PHIL ID #10816

Modes of transmission • Contact with the natural reservoir or

infected animals

• Direct contact with body fluids

– Mucous membranes

– Sexual intercourse

– Break or cut in the skin

• Nosocomial

– Needles, syringes

– Inadequate sterilization

Ebola virus disease • Incubation period 2-21 days

• Clinical picture

– Fever (87%), fatigue (76%), loss of appetite

(64%), vomiting (68%), diarrhea (66%),

headache (53%)

– Internal and external bleeding

– Multi-organ failure

– Death or recovery between 10-14 days after

the onset.

• Case-fatality-70%

Ebola vaccines and treatment

• No approved vaccines/treatment

• Experimental treatment

• Two experimental vaccines

– VSV-EBOV was developed in Canada

– Vaccine is not expected until

January/February 2015.

Ebola outbreak in Liberia

Ebola outbreak in Sierra Leone

Success story

• Travel related cases in Nigeria and

Senegal;

• Nigeria and Senegal were declared

Ebola free after 42 days of the last

reported case.

Situation in Democratic Republic of

Congo • Unrelated to the outbreak in West Africa;

• Equator province only;

• 66 cases (38 confirmed, 28 probable)

• 49 deaths have been reported, including

eight among HCWs;

• 1121 total contacts, 1116 have now

completed 21-day follow-up.

Ebola outbreak in the US

• One travel related case

– Asymptomatic during the travel;

– Felt sick on Sep 24 and was seen in ED on

Sep 26;

– Readmitted on Sep 28.

• Two secondary cases

– Most likely infected during the first few

days after readmission (Sep 28, 29, 30).

How concerned should we be?

• Community outbreak is extremely

unlikely in Canada.

• Sporadic travel related cases are

possible.

• Health care workers in hospitals and

EMS have the highest risk.

Updates from the MOHLTC – Creating Ebola Command table;

– Ontario Asking CMOH to issue directive to

hospitals;

– Designating 10 hospitals as referral hospitals to

treat confirmed cases of Ebola;

– Enhancing inventory and availability of PPE

especially N95 respirators;

– Testing Ebola specimens at PHO provincial labs;

– Assigning outfitted ambulances to transport

potential cases to designated hospitals for

treatment.

Is it airborne?

• NO

• Number of secondary cases

– R0= 1.71 for Guinea

– R0= 1.83 for Liberia

– R0= 2.02 for Sierra Leone

Ebola virus disease in West Africa-the first 9 months of the

epidemic and forward projections. NEJM. Sep 2014

How the outbreak in West Africa is

different from previous outbreaks?

• Cultural practices

– 70% of cases are attributed to burial

practices;

• Mobility;

• Lack of trust to the government and

international aid workers;

• Capital cities were affected.