Ebola

Introduction
 Ebola virus disease, Ebola haemorrhagic fever commonly
termed Ebola.
 One of many haemorrhagic fevers.
 The disease takes its name as it was identified in a village
near Ebola river in Congo, in 1976.
 Viral disease with an acute, serious illness which is often fatal
if untreated.
 Caused by Ebola virus (Filoviridae/RNA virus)
 Fatality upto 90% in outbreaks.
 Transmission
 Fruit bats – natural Ebola virus hosts.
 Introduced into the human population through close contact
with the blood, secretions, organs or other bodily fluids of
infected animals such as chimpanzees, gorillas, fruit bats,
monkeys, forest antelope and porcupines found ill or dead.
 Spreads through human-to-human transmission via direct contact
(through broken skin or mucous membranes) with the blood,
secretions, organs or other bodily fluids of infected people, and
with surfaces and materials (e.g. bedding, clothing) contaminated
with these fluids.
 People remain infectious as long as their blood contains the
virus.
 Health care workers –frequently infected while treating
patients with suspected or confirmed EVD.
 Burial ceremonies in which mourners have direct contact
with the body of deceased person play role in disease
transmission.
Risk factors :
 Close contacts of Infected individuals

 Family members
 Care givers
 Health care personnel
 People involved in managing dead bodies
 Epidemiology
 Ebola virus first appeared in 1976, causing simultaneous
epidemics of severe hemorrhagic fever (550 human cases) in
Zaire and Sudan. Later confirmed as 2 different epidemics.
 Epidemics - usually begins with single case acquired from an
unknown reservoir in nature (fruit bats), and spread mainly
through close contact with sick person or their body fluids,
either at home or in the hospital.
 Associated with inter human spread (particularly in the hospital
setting) and the use of unsterilized needles and syringes.
 After an interval of apparent inactivity of almost 20 years,
the Zaire Ebola virus recurred in a major epidemic (317
cases) in the DRC in 1995 with high mortality rate – 88%.
 Smaller epidemics in Gabon in 1994–1996. The epidemic
smoldered, when intense nosocomial transmission forced
closure of the hospitals. The last case was reported in June
1995.
 Separate emergences of Ebola virus (Zaire) were detected in
Gabon in 1994–2003, usually in association with deep-forest
exposure and subsequent familial and nosocomial transmission.
 After its first documented activity in 1976, the Sudan Ebola
species returned in epidemic form to cause an indolent
outbreak in Uganda in 2000–2001. This outbreak claimed the
lives of 224 (53%) of 425 patients.
 Past important outbreaks of EHF
Year Country Cases Deaths Case fatality
2012 DRC 57 29 51%
2012 Uganda 24 17 71%
2008 DRC 32 14 44%
2007 Uganda 149 37 25%
2007 DRC 264 187 71%
2005 Congo 12 10 83%

2003 (Jan-Apr) Congo 143 128 90%

2000 Uganda 425 224 53%

1995 DRC 315 254 81%
1976 Sudan 284 151 53%
1976 DRC 90%
 Clinical Manifestations
 Incubation period 7-10 days(range 3-16 days)
 Abrupt development of fever, severe headache, malaise, myalgia,
nausea and vomiting.
 Continued fever is associated with diarrhoea (often severe), chest
pain (accompanied by cough) and depressed mentation.
 Maculopapular rash appears around day 5-7 and is followed by
desquamation; in light skinned people.
 Bleeding may begin about this time and is apparent from any
mucosal site and into the skin.
 Additional findings include edema of the face, neck, and/or
scrotum; hepatomegaly; flushing; conjunctival injection; and
pharyngitis.
 Around 10–12 days after the onset of disease, the sustained
fever may break, with improvement and eventual recovery of
the patient.
 Recrudescence of fever may be associated with secondary
bacterial infections or possibly with localized virus
persistence.
 Late hepatitis, uveitis, and orchitis have been reported, with
isolation of virus from semen or detection of PCR products
in vaginal secretions for several weeks.
Laboratory findings
 Leokopenia - common early; neutrophilia onsets later
 Low platelet count- sometimes as low as 50,000/L.
 High SGPT &SGOT; sometimes high bilirubin.
 Elevated serum amylase level sometimes confusing with
pancreatitis.
 protinuria
 Derranged kidney function.
 Evidence of DIC – raised FDP, d-dimer.
Diagnosis
 Virus isolation by cell culture.
 Antigen detection with ELISA – robust diagnostic modality
 Reverse transcription PCR
 IgM and IgG in recovering patients.
 Indirect fluorescent antibody test.
 Treatment
 No virus specific therapy is available.
 Supportive treatment –treatment of shock
- Balancing the patient’s fluids and electrolytes
-Maintaining their oxygen status and blood pressure
-Treating them for any complicating infections
 Early supportive care with rehydration, symptomatic treatment
improves survival.
 There is as no licensed treatment proven to neutralize the virus
but a range of blood, immunological and drug therapies are
under development.
 An adenovirus-vectored Ebola glycoprotein gene has proved
protective in nonhuman primates and is undergoing phase 1
trials in humans.
 Prevention & control
 No vaccine or antiviral drug currently available
 Barrier nursing precautions – use of personnel protective
equipments, gloves ,mask, isolation.
 Community engagement is key to successfully controlling
outbreaks.
 Good outbreak control relies on applying a package of
interventions, namely case management, surveillance and contact
tracing, a good laboratory service, safe burials and social
mobilisation.