This is useful for those who are interested on EVD.

1. Ebola virus disease
Ravi Kanta Mishra
MPH, Third Batch
National Medical College, Birgunj

2. Introduction
 Ebola first appeared in 1976 in 2
simultaneous outbreaks, in Nzara,
Sudan, and in Yambuku, Democratic
Republic of Congo.
 The latter was in a village situated near
the Ebola River, from which the disease
takes its name.

3. Genus Ebolavirus is 1 of 3 members of
the Filoviridae family (filovirus), along with genus
Marburgvirus and genus Cuevavirus. Genus
Ebolavirus comprises 5 distinct species:
 Bundibugyo ebolavirus (BDBV)
 Zaire ebolavirus (EBOV)
 Reston ebolavirus (RESTV)
 Sudan ebolavirus (SUDV)
 Taï Forest ebolavirus (TAFV).

4. Natural host of Ebola virus
In Africa, fruit bats, particularly species of the
genera Hypsignathus monstrosus, Epomops
franqueti and Myonycteris torquata, are
considered possible natural hosts for Ebola
virus. As a result, the geographic distribution
of Ebolaviruses may overlap with the range of
the fruit bats.

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

6. Transmission
 Close contact with the blood, secretions, organs
or other bodily fluids of infected animals.
 In Africa, infection has been documented through
the handling of infected chimpanzees, gorillas,
fruit bats, monkeys, forest antelope and
porcupines found ill or dead or in the rainforest.

7. Transmission…
 Ebola then spreads in the community through
human-to-human transmission, with infection
resulting from direct contact (through broken
skin or mucous membranes) with the blood,
secretions, organs or other bodily fluids of
infected people, and indirect contact with
environments contaminated with such fluids.

8. Transmission…

9. Signs and Symptoms
EVD is a severe acute viral illness often
characterized by
 Sudden onset of fever
 Joint and muscle aches
 Weakness
 Stomach pain
 Lack of appetite
 intense weakness,
 headache and sore throat.
This is followed by vomiting, diarrhoea, rash,
impaired kidney and liver function, and in some
cases, both internal and external bleeding.
Laboratory findings include low white blood cell and
platelet counts and elevated liver enzymes.

10. Some patients may experience:
 Red Eyes
 Hiccups
 Cough
 Chest pain
 Difficulty breathing
 Difficulty swallowing
 Bleeding inside and outside of the body
People are infectious as long as their blood and
secretions contain the virus. Ebola virus was isolated
from semen 61 days after onset of illness in a man
who was infected in a laboratory.
 The incubation period, that is, the time interval from
infection with the virus to onset of symptoms, is 2 to
21 days, 8-10 days is most common.

11. Diagnosis
Other diseases that should be ruled out
before a diagnosis of EVD can be made
include:
malaria, typhoid fever, shigellosis, cholera,
leptospirosis, plague, rickettsiosis, relapsing
fever, meningitis, hepatitis and other viral
haemorrhagic fevers.

12. Diagnosis..
Ebola virus infections can be diagnosed
definitively in a laboratory through several types
of tests:
 antibody-capture enzyme-linked immunosorbent
assay (ELISA)
 antigen detection tests
 serum neutralization test
 reverse transcriptase polymerase chain reaction
(RT-PCR) assay
 electron microscopy
 virus isolation by cell culture.
Samples from patients are an extreme biohazard
risk; testing should be conducted under
maximum biological containment conditions.

13. Vaccine and treatment
 No licensed vaccine for EVD is available.
Several vaccines are being tested, but none
are available for clinical use.
 Severely ill patients require intensive
supportive care. Patients are frequently
dehydrated and require oral rehydration with
solutions containing electrolytes or
intravenous fluids.
 No specific treatment is available. New drug
therapies are being evaluated.

14. Prevention and Control

15. How can Ebola infections be prevented ?
 There is no vaccine or treatment for Ebola virus
disease.
 If you are or have been in a region where an
Ebola outbreak has occurred, take these
precautions.

16. 1. Avoid direct contact with blood, saliva, vomit,
urine and other bodily fluids of people with
Ebola virus disease or unknown illnesses.
 Avoid direct contact with bodies of people who died
of Ebola virus disease or unknown illnesses.
 Avoid contact with any medical equipment, such as
needles, contaminated with blood or bodily fluids.
 If you are a health care worker, practise strict
infection control measures. This includes isolating
infected individuals and using personal protective
equipment (gowns, masks, goggles and gloves).
 If you are a health care worker, properly use and
disinfect instruments and equipment used to treat or
care for patients with Ebola—like needles and
thermometers—before throwing them out.

17. 2. Avoid close contact with wild animals and
avoid handling wild meat.
Avoid potential carriers, both live and dead,
since both can spread the virus. Potential
carriers of the virus include:
 chimpanzees
 gorillas
 monkeys
 forest antelope
 pigs
 porcupines, and
 fruit bats

18. 3. Know the symptoms of Ebola virus
disease and see a health care provider if
they develop.
 Seek medical attention immediately if a fever
and any other symptoms arise during or after
travel.
 Be sure to tell your health care provider that
you have travelled to a region where Ebola
virus disease was present.

19. Prevention
1. Controlling Reston ebola virus in domestic
animals
2. Reducing the risk of Ebola infection in people
3. Controlling infection in health-care settings

20. Case Definition for Ebola Virus Disease
(EVD)
Early recognition is critical for infection control.
Healthcare providers should be alert for and
evaluate any patients suspected of having EVD.
Person Under Investigation (PUI)
A person who has both consistent symptoms and
risk factors as follows:
1) Clinical criteria, which includes fever of greater
than 38.6 degrees Celsius or 101.5 degrees
Fahrenheit, and additional symptoms such as
severe headache, muscle pain, vomiting,
diarrhea, abdominal pain, or unexplained
hemorrhage; AND
2) Epidemiologic risk factors within the past 21
days before the onset of symptoms, such as
contact with blood or other body fluids or human
remains of a patient known to have or suspected
to have EVD; residence in—or travel to—an area
where EVD transmission is active*; or direct
handling of bats, rodents, or primates from

21. Definition…
Probable Case
 A PUI who is a contact of an EVD case with either
a high or low risk exposure .
Confirmed Case
 A case with laboratory confirmed diagnostic
evidence of ebola virus infection.

22. Definition..
Contacts of an EVD Case
Contacts of an EVD case have different levels of exposure
risk, as follows:
High risk exposures
 A high risk exposure includes any of the following:
 Percutaneous, e.g. the needle stick, or mucous membrane
exposure to body fluids of EVD patient
 Direct care or exposure to body fluids of an EVD patient
without appropriate personal protective equipment (PPE)
 Laboratory worker processing body fluids of confirmed
EVD patients without appropriate PPE or standard
biosafety precautions
 Participation in funeral rites which include direct exposure
to human remains in the geographic area where outbreak
is occurring without appropriate PPE

23. Definition…
Low risk exposures
 A low risk exposure includes any of the following
 Household member or other casual contact1 with
an EVD patient
 Providing patient care or casual contact without
high-risk exposure with EVD patients in health
care facilities in EVD outbreak affected countries*
No known exposure
 Persons with no known exposure were present in
an EVD outbreak affected country* in the past 21
days with no low risk or high risk exposures.

24. Epidemiology

25. Cases of Ebola Hemorrhagic Fever in Africa, 1976 - 2014
Country Town Cases Deaths Species Year
Dem. Rep. of Congo Yambuku 318 280 Zaire ebolavirus 1976
South Sudan Nzara 284 151 Sudan ebolavirus 1976
Dem. Rep. of Congo Tandala 1 1 Zaire ebolavirus 1977
South Sudan Nzara 34 22 Sudan ebolavirus 1979
Gabon Mekouka 52 31 Zaire ebolavirus 1994
Ivory Coast Tai Forest 1 0 Taï Forest ebolavirus 1994
Dem. Rep. of Congo Kikwit 315 250 Zaire ebolavirus 1995
Gabon Mayibout 37 21 Zaire ebolavirus 1996
Gabon Booue 60 45 Zaire ebolavirus 1996
South Africa Johannesburg 2 1 Zaire ebolavirus 1996
Uganda Gulu 425 224 Zaire ebolavirus 2000
Gabon Libreville 65 53 Zaire ebolavirus 2001
Republic of Congo Not specified 57 43 Zaire ebolavirus 2001
Republic of Congo Mbomo 143 128 Zaire ebolavirus 2002
Republic of Congo Mbomo 35 29 Zaire ebolavirus 2003
South Sudan Yambio 17 7 Zaire ebolavirus 2004
Dem. Rep. of Congo Luebo 264 187 Zaire ebolavirus 2007
Uganda Bundibugyo 149 37 Bundibugyo ebolavirus 2007
Dem. Rep. of Congo Luebo 32 15 Zaire ebolavirus 2008
Uganda Luwero District 1 1 Sudan ebolavirus 2011
Uganda Kibaale District 11* 4* Sudan ebolavirus 2012
Dem. Rep. of Congo
Isiro Health
Zone
36* 13* Bundibugyo ebolavirus 2012
Uganda Luwero District 6* 3* Sudan ebolavirus 2012
Guinea, Sierra Leone,
*Numbers reflect laboratory cmonuflitrimpleed cases only. 1176* 660* Zaire ebolavirus 2014
Liberia, Nigeria

26. Year Country
Ebolavirus
species Cases Deaths Case fatality
2012 Democratic Republic of Congo Bundibugyo 57 29 51%
2012 Uganda Sudan 7 4 57%
2012 Uganda Sudan 24 17 71%
2011 Uganda Sudan 1 1 100%
2008 Democratic Republic of Congo Zaire 32 14 44%
2007 Uganda Bundibugyo 149 37 25%
2007 Democratic Republic of Congo Zaire 264 187 71%
2005 Congo Zaire 12 10 83%
2004 Sudan Sudan 17 7 41%
2003 (Nov-Dec) Congo Zaire 35 29 83%
2003 (Jan-Apr) Congo Zaire 143 128 90%
2001-2002 Congo Zaire 59 44 75%
2001-2002 Gabon Zaire 65 53 82%
2000 Uganda Sudan 425 224 53%

27. 1996 South Africa (ex-Gabon) Zaire 1 1 100%
1996 (Jul-Dec) Gabon Zaire 60 45 75%
1996 (Jan-Apr) Gabon Zaire 31 21 68%
1995 Democratic Republic of Congo Zaire 315 254 81%
1994 Cote d'Ivoire Taï Forest 1 0 0%
1994 Gabon Zaire 52 31 60%
1979 Sudan Sudan 34 22 65%
1977 Democratic Republic of Congo Zaire 1 1 100%
1976 Sudan Sudan 284 151 53%
1976 Democratic Republic of Congo Zaire 318 280 88%

28. Key Facts
 Ebola virus disease (EVD), formerly known as Ebola
haemorrhagic fever, is a severe, often fatal illness in
humans.
 EVD outbreaks have a case fatality rate of up to 90%.
 EVD outbreaks occur primarily in remote villages in
Central and West Africa, near tropical rainforests.
 The virus is transmitted to people from wild animals
and spreads in the human population through human-to-
human transmission.
 Fruit bats of the Pteropodidae family are considered
to be the natural host of the Ebola virus.
 Severely ill patients require intensive supportive care.
No licensed specific treatment or vaccine is available
for use in people or animals.

29. Scenerio of Nepal Regarding
EVD
 No cases found yet
 Establish Health Desk at Tribhuwan International
Airport (From Today)
 Referral hospital Sahid Sukraraj Tropical Hospital,
Teku
 Isolation ward established at Zonal, Regional
Hospitals
 Formally Call Technical Export from WHO by
Health Minister Khag Raj Adhikari
 Awareness through Radio ,Television and
Newspaper.

31. Refrences:
http://www.who.int/mediacentre/factsheets/fs103/en/
http://www.cdc.gov/vhf/ebola/symptoms/
http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-prevention-
eng.php

32. THANK YOU