update on ebola and local response
TRANSCRIPT
Ebola: Update and Local Response
Dr Nigel Calvert
November 2014
Topics
• Ebola
– History
– Virology
– Transmission and Natural History
– Clinical Features and Treatment
• Current Outbreak
– Latest situation in Africa
– Local implications and actions
Topics
• Ebola
– History
– Virology
– Transmission and Natural History
– Clinical Features and Treatment
• Current Outbreak
– Latest situation in Africa
– Local implications and actions
Ebola History
• First appeared in 1976
Ebola Past Outbreaks
• Prior to current outbreak:
– 34 outbreaks involving 2,101 patients and 1,548 deaths.
– Mostly Africa (2 in Russia)
– In Africa, animal outbreaks in primates have been noted which appear to decimate the populations
• Bats & Primates
• Main reservoir probably bats
The Ebola Virus
• RNA Virus
• Filovirus (like Marburg)
• Survival dependent on natural reservoir
– Thought to remain viable for several weeks on objects.
Ebola Virus Ecology
Ebola Virus Clinical Details
• Incubation period 2-21 days – most will develop symptoms
between 8-10 days after exposure.
• Initially mild similar flu-like illness
• Symptoms become progressively worse – Abdominal Pain – Diarrhoea – Vomiting – Bleeding
• Death is normally from shock usually preceded by multi-organ failure and bleeding.
Ebola Transmission 1
• ALL body fluids; blood, tears, saliva, sweat vomit, semen, diarrhoea.
• Viral load increases through the disease and hence infectivity increases.
• Low infective dose maybe as few as 10 organisms
Ebola Transmission 2
• Can be transmitted by contaminated objects
– Clothing
– Bedding
• Bodies after death are a high infection risk
• Sexually Transmitted
– After clinical disease the virus can be present in the semen for 7 weeks and infection has been documented after 61 days
Ebola Treatment
• Supportive Measures – Fluids
• Drug Treatments are in development – BCX 4430
• effective against Marburg and Ebola in animal models
• approaching phase 1 human trials
– ZMAPP • been used in the current
outbreak though still needs to go through human trails
Ebola vaccines
• Two vaccines being developed
– GSK (UK)
• undergoing phase 1 human trails
• may be ready for deployment in 2015.
– Johnson & Johnson (USA)
• > 12 months behind
Topics
• Ebola
– History
– Virology
– Transmission and Natural History
– Clinical Features and Treatment
• Current Outbreak
– Latest situation in Africa
– Local implications and actions
Current Outbreak of Ebola
Local Actions
• Viral Haemorrhagic Fever Contingency Group – DGRI
• Planning • Walk-through Exercise • Containment Facilities • Training • Personal Protective Equipment
– Public Health • Information to Primary care • Information to Education • Specific Page on Health Protection Website • Contact Tracing Arrangements
Immediate Actions
Case Study
• Gentleman from D&G returned from West Africa having been bitten by a snake – Receiving treatment in Glasgow
• Had visited several healthcare facilities where Ebola patients may have been treated – No definite history of direct contact
• Decision made with Glasgow to monitor as potential Ebola case – Daily contact for 21 days with Health Protection Team
• Temperature • Any relevant symptoms
Further Information
• www.dghps.org/home/ebola
• 01387 272724