This is a presentation I gave to the Pierce County Medical Reserve Corps October 6, 2014

1. Matthew Rollosson, RN, MPH&TM
6 October 2014

2. Arenaviridae
◦Argentine, Bolivian, Brazilian, Chapare, Venezuelan hemorrhagic fevers
◦Lassa fever
Bunyaviridae
◦Crimean-Congo hemorrhagic fever
◦Hantaviruses
◦Rift Valley Fever
Filoviridae
◦Ebola
◦Marburg
Flaviviridae
◦Dengue
◦Yellow fever

3. Filo: thread
◦Three genera:
Ebolavirus
Cuevavirus (Spain)
Marburgvirus (Germany)
◦Ebola
Five species
Bunbidugyo (Uganda)
Reston (Virginia, U.S.)
Sudan
Taï Forest (Côte d’Ivoire)
Zaïre (Congo)
CDC/Frederick A. Murphy
CDC/NIAID

4. 1968, Germany and Yugoslavia
◦Laboratory workers exposed to blood and tissue of African green monkeys from Uganda
Secondary transmission to family and other health care workers
◦31 people infected
7 deaths (case fatality 23%)
◦Sporadic outbreaks in Africa
Case fatality as high as 90%

5. 1989, Reston, Virginia, U.S.
◦Cynomolgus macaques imported from the Philippines
◦Highly lethal to primates
Also infects pigs
◦Not pathogenic to humans
Lab workers showed serological evidence of infection, but did not become ill

6. 1976, Yambuku, Zaïre (now the Democratic Republic of the Congo)
◦Near the Ebola River
Occurred at the same time as first identified outbreak of Sudan ebolavirus
◦Species that causes most Ebola outbreaks
Current outbreak in West Africa

7. Fruit bats are most likely the natural reservoir for the virus
◦Outbreaks frequently associated with mining
Infects monkeys and apes
◦Large die-offs of chimpanzees and gorillas
◦Taï Forest ebolavirus
One human infection
Acquired during autopsy of a chimpanzee
Outbreaks may be associated with hunting or butchering animals or eating infected meat
◦Bat soup
◦Bushmeat

8. Direct contact with blood or body fluids of a symptomatic person
◦Skin
Cuts, abrasion
◦Mucous membranes
◦Parenteral
Reusing unsterilized needles
◦Funeral ceremonies
Respiratory droplets?
◦Not airborne
Not effectively transmitted by fomites

9. Incubation period
◦2 to 21 days
Mean 4 to 10 days
◦Not infectious until symptom onset
Sudden onset
◦Fever
◦Muscle pain
◦Fatigue
◦May be a transient maculopapular rash

10. Vomiting, diarrhea
Liver failure
Abdominal pain
Bleeding disorders
◦Gastrointestinal bleeding
◦Bleeding from venipuncture sites
◦Mucous membranes
Renal failure
Neurological symptoms

11. Death or recovery
◦7 to 14 days after symptom onset
◦Prolonged convalescence
◦Immunity
Convalescent serum as treatment?
◦Virus may be present in semen up to 7 weeks after recovery
Rehydration and supportive care improve survival

12. March 22
◦First cases reported
◦Guinea: 49 people
August 31
◦3,685 cases
September 23
◦6,574 cases
Liberia: 3,458 cases
Sierra Leone: 2,021 cases
CDC, 2014c

13. CDC, 2014c

14. Liberia
◦Doubling every 15- 20 days
Sierra Leone
◦Doubling every 30- 40 days
CDC estimates that cases may be underreported by a factor of 2.5
Cumulative number of Ebola virus disease cases reported – five countries, West Africa, March 29 – September 20, 2014
CDC, 2014d

15. July 20
◦Ill patient travels from Liberia to Lagos, Nigeria
Nigeria
Most populous country in Africa
Lagos
Most populous city in Africa
Air, ground, and sea transit hub
July 23
◦Ebola Incident Management Center (EOC) activated

16. CDC, 2014b

17. Contact tracing
◦894 contacts identified
◦18,500 face-to-face visits conducted
Isolation of suspected cases
◦No transmission within isolation wards
Hospitalization of confirmed cases
Coordination of donors, partner organizations, and response teams

18. 19 laboratory-confirmed cases, 1 probable
◦8 deaths (40%)
No new cases since August 31
CDC, 2014b

19. September 20
◦Passenger arrives in Dallas from Liberia
September 24
◦Patient became ill
September 26
◦Patient seen at hospital
◦Discharged
September 28
◦Patient admitted with symptoms consistent with EVD

20. October 2
◦Court-ordered home isolation of contacts
CDC does not recommend quarantining asymptomatic contacts of Ebola cases
October 3
◦50 contacts identified
10 with high risk exposures
Daily fever monitoring
October 20
◦?

21. According to the CDC,
◦Any U.S. hospital that is following CDC’s infection control recommendations and can isolate a patient in their own room with a private bathroom is capable of safely managing a patient with Ebola
◦Health care professionals in the U.S should immediately report to their state or local health department any person being evaluated for EVD if the medical evaluation suggests that diagnostic testing may be indicated
◦ CDC is NOT recommending that asymptomatic contacts of EVD patients be quarantined, either in facilities or at home

22. CDC has consulted state and local health departments on over 100 people with travel history and symptoms that suggested EVD
◦14 considered to be truly at risk
13 tested for Ebola
All were negative

23. Doctors Without Borders
◦www.doctorswithoutborders.org
International Medical Corps
◦https://internationalmedicalcorps.org
Partners in Health
◦www.pih.org
USAID
◦www.usaid.gov/ebola/volunteers

24. Bausch, D. G., Towner, J. S., Dowell, S. F., Kaducu, F., Lukwiya, M., Sanchez, A., et al. (2007). Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. Journal of Infectious Diseases, 196(Supple. 2), S142-S147.
Blumberg, L., Enria, D., & Bausch, D. G. (2014). Viral hemorrhagic fevers. In J. Farrar, P. J. Hotez, T. Junghanss, G. Kang, D. Lalloo, & N. J. White (Eds.) Manson's tropical diseases, 23rd Ed. [Electronic version]. Elsevier.
Centers for Disease Control and Prevention. (2014). CDC and Texas Health Department confirms first Ebola case diagnosed in the U.S. http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed- case.html.
Centers for Disease Control and Prevention. (2014). Ebola virus disease outbreak – Nigeria, July-September, 2014. Morbidity and Mortality Weekly Report, 63(39), 867-872. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm.

25. Centers for Disease Control and Prevention. (2014). Ebola virus disease outbreak – West Africa, September, 2014. Morbidity and Mortality Weekly Report, 63(39), 865-866. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a4.htm.
Centers for Disease Control and Prevention. (2014). Estimating the future number of cases in the Ebola epidemic – Liberia and Sierra Leone, 2014-2015. Morbidity and Mortality Weekly Report, 63(3), 1-14. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm.
Centers for Disease Control and Prevention. (2014). Interim guidance for monitoring and movement of persons with Ebola virus disease exposure. http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of- persons-with-exposure.html.
Centers for Disease Control and Prevention. (2014). Questions and answers on Ebola. http://www.cdc.gov/vhf/ebola/outbreaks/2014- west-africa/qa.html.

26. Center for Infectious Disease Research and Policy. (2014). Texas contact tracing identifies 50 for Ebola fever monitoring. http://www.cidrap.umn.edu/news-perspective/2014/10/texas-contact- tracing-identifies-50-ebola-fever-monitoring.
Center for Infectious Disease Research and Policy. (2014). Texas issues Ebola home isolation court order. http://www.cidrap.umn.edu/news- perspective/2014/10/texas-issues-ebola-home-isolation-court-order.
Frieden, T. (2014). Why U.S. can stop Ebola in its tracks. http://www.cnn.com/2014/10/02/opinion/frieden-ebola-first- patient/index.html.
Geisbert, T. W. (2014). Marburg and Ebola hemorrhagic fevers (Filoviruses). In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds.). Mandell, Douglas, and Bennett's principles and practice of infectious diseases, 8th Ed. [Electronic version]. Elsevier.

27. Hartman, A. L. (2013). Ebola and Marburg virus infections. In, A. J. Magill, D. R. Hill, T. Solomon, & E. T. Ryan (Eds.) Hunter's tropical medicine, 9th Ed. [Electronic version]. Elsevier.
World Health Organization. (2014). Ebola virus disease. Retrieved 1 October 2014 from http://www.who.int/mediacentre/factsheets/fs103/en.
Tanzania, August 2014