EBOLA

1. Overview of Ebola Virus Disease
Dr. Dinesh Kr Jain, MD.,
Assistantprofessor,
Department of Microbiology,
SMS Medical college, Jaipur

2. Ebola –the beginning
• First reported in August, 1976 in Yambuku, a town in
the north of Zaïre (now Republic of Congo).
• A 14-year-old school reported with fever, treated for
malaria.
• A week later, he had uncontrolled vomiting, bloody
diarrhea, difficulty in breathing and bleeding from his
nose, mouth, and anus.
• He died 14 days after the onset of symptoms.
• He started an epidemic that killed 280 of the 313
infected persons (CFR 88%).

3. Past Outbreaks of Ebola
• Over 20 outbreaks since the first in 1976 up to 2012.
• Only 7 outbreaks that recorded with more than 100
cases.
• Mainly in countries in Central Africa (Sudan, Gabon,
Congo, Uganda)
• High case fatality rate (up to 90%)
• All of them got contained.
Source: http://www.who.int/mediacentre/factsheets/fs103/en/

4. Current Outbreak
• Started in December 2013 in Guinea.
• Reported to WHO in March 2014.
• Affected 4 west African Countries of Guinea,
Sierra Leone, Liberia and Nigeria
• Travel related cases reported from Senegal,
USA and Spain.

5. Current Outbreak
Sl. No. Country Cases Deaths
1. Guinea 1472 843
2. Liberia 4249 2458
3. Sierra Leone 3252 1183
4. Nigeria 20 08
5. Senegal 01 00
6. United States
of America
02 01
7. Spain 01 00
Total 8997 4493
427 health care workers have developed the disease in the first
four affected countries of which 236 have died
Source: WHO

6. Current Outbreak-Cont’d
• Moved from Rural to urban area; affected large
cities.
• Weak health infrastructure / lack of health
resources.
• Lack of knowledge of the disease.
• Lack of trust on Health care providers.
• Not seeking health care
• Social rituals / burial rituals
• Delayed response

7. Ebola virus species
• Zaire ebola virus: 1976, Democratic Republic of
Congo.
• Sudan ebola virus: 1976, Sudan.
• Bundibugyo ebola virus: 2007, Uganda.
• Taї Forest ebola virus (formerly Côte d’Ivoire
ebola virus): 1994, Ivory Coast. Single case,
veterinary worker handling primate.
• Reston ebolavirus: 1989, Philippines.
• Macaques, swine.
• No clinical disease in Humans.

8. Reservoir and transmission to humans
• Fruit bats are reservoir of infection.
• Bats infect chimpanzees, gorillas, forest
antelopes, porcupines.
• Humans handle them and eat their meat (bats,
chimpanzees, gorillas)
• Infected human passes infection from person
to person.

9. 9

11. RESERVOIR-FRUIT BATS???

12. Natural host
 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
Ebola viruses may overlap with the range of
the fruit bats.

13. Incubation period : 2-21 days
Infectious Period:
•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 infected in a laboratory.

14. Route of transmission
• Direct contact through broken skin or unprotected mucous
membranes, eg the eyes, nose, or mouth, with the blood or
body fluids (urine, feces, saliva, semen, and other
secretions) of a person who is sick with Ebola,
• Indirect contact with environments contaminated
with such fluids.
• With objects like needles that have been contaminated
with the virus, or infected animals.
• A person infected with Ebola virus is not contagious
until symptoms appear

15. Disease Transmission
• Health-care workers have frequently been infected
while treating patients with suspected or confirmed
EVD.
• This has occurred through close contact with patients
when infection control precautions are not strictly
practiced.

16. 16
 In Africa Ebola may spread as a result of hunting,
processing, and consuming infected animals (e.g.,
bush meat).
Route of transmission

17. PRACTICE OF EATING BUSH MEAT

18. 18
Clinical features

19. Clinical features
• Incubation period 8-10 days (range 2-21)
• Sudden onset of Fever >38.60C
• Flu-like symptoms: chills, myalgias, and malaise,
sore throat
• Nausea, vomiting , abdominal pain, diarrhea
• Respiratory symptoms of chest pain, shortness of
breath and cough
• CNS symptoms: Headache, confusion and coma

20. Clinical features-cont’d
• Rash occurs around day 5
• Hypotension, peripheral edema
• Bleeding manifestations develop in >50%
(internal/external)
• Can vary from petechiae & easy bruising, to
mucosal hemorrhage, uncontrolled bleeding
and massive GI blood loss
• Multi-organ dysfunction : kidneys and Liver

21. Pathogenesis
• Ebola virus enters the patient through mucous
membranes, breaks in the skin, or parenterally and infects
many cell, including monocytes, macrophages, dendritic
cells, endothelial cells, fibroblasts, hepatocytes, adrenal
cortical cells and epithelial cells.
• Ebola virus migrates from the initial infection site to
regional lymph nodes and subsequently to the liver,
spleen and adrenal gland.
• lymphocytes undergo apoptosis resulting in decreased
lymphocyte counts

22. Pathogenesis (cont.)
• Hepatocellular necrosis occurs and is associated with
dysregulation of clotting factors and subsequent
coagulopathy.
• Adrenocortical necrosis also can be found and is associated
with hypotension and impaired steroid synthesis.
• Ebola virus appears to trigger a release of pro-inflammatory
cytokines with subsequent vascular leak and impairment of
clotting ultimately resulting in multi-organ failure and
shock.

23. Ebola hemorrhagic fever
Target Organs and Damage Methods
Target mainly small capillary vessels. Attach to walls, cause
leakage of blood and serum into surrounding tissue.
When white blood cells attack the virus, they dissolve – this
releases a chemical into the blood stream that signals the
release of other chemicals (pro-inflammatory cytokines, pro-
coagulants, and anticoagulants)
These injure blood vessels even worse, resulting in permanent
bleeding.

25. Ebola Virus Diseases
Collection, Storage and Transportation
of samples

26. Ebola virus
• Ebola virus is classified as risk group 4 virus
• Clinical samples should be collected using all
universal precautions
• Handled in specially-equipped, high biosafety
level laboratories (BSL 3 plus or 4).

27. Requirements for sample
collection
Things necessary for collection of
samples
• PPE: Gown, mask, eye-
shield/goggles, gloves
• Syringe with needle, tourniquet,
spirit swabs, sample collection-
plastic vials/vacutainer tube
• Labels
• For discard: Freshly prepared 1%
hypochlorite solution

29. From whom the samples are to be collected?
Case definition
• The samples should be collected from any person ill or
deceased who has or had fever with acute clinical
symptoms and signs of hemorrhage, such as bleeding
of the gums, nose-bleeds, conjunctival injection, red
spots on the body, bloody stools and/or melaena (black
liquid stools), or vomiting blood (haematemesis) with
the history of travel to the affected area.
OR
• Any person (living or dead) having had contact with a
clinical case of EBVD and with a history of acute fever.

30. When to collect sample
• 3 days after onset of symptoms (most notably fever)
• If < 3 days subsequent sample required to
completely rule out EVD
• What sample/s is to be collected?
• Ante-mortem: Blood sample: 4ml : in plain and/or EDTA
vial (plastic vial)
• Serum or Plasma
• Postmortem: Tissue sample (liver, spleen, bone marrow,
kidney, lung and brain)

31. Collection of Samples
• Use infection control precautions
– Wash hands thoroughly with soap
and water or alcohol‐based hand
gel before and after the procedure
• Wear gown, eye-shield, mask and
gloves

32. Collection of Samples
• Make the patient comfortable and
carefully collect the blood sample
• Label the tubes: Name/Age/ Doc/ Hosp.
ID
• Boldly label the tube as “Suspected
Ebola”
• Dispose syringe, needle and swab in
hypochlorite solution or any other
disinfectant
• Disinfect the outer surface of container
using 1% hypochlorite
• Remove PPE and carefully discard in
Yellow bag.

33. Packaging the samples
Triple packaging
• The sample containing vials should be
kept in good quality plastic bags which
should either be sealed or tied with
rubber bands so that inside material, if
leaks, should not come out of the bag.
• This plastic bag should be placed in
another plastic container which should
be sealed with adhesive tape.
• This carrier should then be placed in
another plastic bag sealed with rubber
bands and be placed in a thermocol or
vaccine carrier containing ice.
• If plastic container is not available then
good quality of double plastic bags can
be used.
• Boldly label the outermost carrier “Ebola
Testing”

34. Proforma
• Name/Father’ s Name/Age/Gender/Hosp ID/Address
• History of travel to the African countries in last 21 days: Liberia, Guinea, Sierra Leone &
Nigeria
Yes/No If Yes, which one: When (dates): Date of return:
• History of contact with the blood or bodily fluids of an Ebola infected symptomatic person
or though infected objects -Yes/No , If yes, the details:
• Signs & Symptoms: Date of admission:
• Date of onset of fever
• Hemorrhages: Yes/ No , if yes, site:
Gums/Hematemesis/malena/Conjunctiva/Epistaxis/Purpura/Petechiae/Ecchymosis
• Any other site (specify)
Headache/Joint aches/Muscle aches/Diarrhea/Vomiting/Stomach pain
• Condition of the patient: Stable/critical
• Date of collection of sample
• Type of sample
• Information of Sender: Signatures/Designation/Contact details

35. Storage and Transportation
• Transport samples in vaccine carrier in cold chain
maintaining temperature of 4-8 degrees C.
• Send the sample immediately after collection to
designated laboratory.
• If delay is anticipated, carefully store samples in a
fridge at 4-8 degrees C.

36. Where the samples should be
transported?
• Samples should be sent to the following
laboratories under cold chain with prior
intimation
– National Institute of Virology, Pune
– National Centre for Disease Control, Delhi

37. Laboratory diagnosis of
Ebola Virus Diseases

38. Course of Disease and
Virus shedding
• Not transmissible prior to onset of symptoms
• All body fluids (blood, urine, saliva, feces etc.) can carry virus
• Virus quantity increases to death, usually 9-10 days post-
onset of symptoms
• If patient survives to day 14, increased chance of survival
• Convalescence/resolution of viremia

39. Laboratory Diagnosis
• Antibody-capture enzyme-linked
immunosorbent assay (ELISA)
• Antigen-capture detection tests
• Serum neutralization test
• Reverse transcriptase polymerase chain
reaction (RT-PCR) assay
• Electron microscopy
• Virus isolation by cell culture.

41. Laboratory Diagnostics - General
• Appropriate test depends on the timing of the sample
(diagnostic testing is useless unless there are symptoms
present)
• Blood and sera are best specimens for testing in live
patients
• Tissues (spleen, liver, skin snips) may be tested if patient is
deceased.
• Oral swabs can also be used in extreme circumstances but is
not recommended for routine testing (not as sensitive,
shorter window for positives, etc)

42. Laboratory facility
• All clinical specimens to be
processed in a class II biological
safety cabinet following Biosafety
level 3. viz BSL 3 laboratories.
• Universal precautions and PPE –
Fluid Resistant or impermeable
Gown, mask, face shield and
gloves
• Virus isolation should be done
only in BSL 4 facility

43. Laboratory Diagnosis of EVBD
Infection Timeline Diagnostic tests available
Within a few days after
symptoms begin
• Virus isolation
• Molecular Tests
• RT-PCR
• Real Time RT-PCR
• Antigen capture Enzyme Linked Immunosorbent
Assay
• IgM ELISA
Later in disease course or
after recovery
• IgM and IgG antibodies
Retrospectively in
deceased patients
• Immunohistochemistry testing
• PCR
• Virus isolation

44. Tests carried out at NCDC, Delhi
• BSL 3 laboratory
• ELISA for antigen detection
• RT-PCR and Real Time PCR
• Sequencing

45. Treatment (1)
• No specific vaccine or medicine (e.g., antiviral drug) has been
proven to be effective against Ebola.
• Symptoms of Ebola are treated as they appear. The following basic
interventions, when used early, can increase the chances of
survival.
– Providing intravenous fluids and balancing electrolytes (body salts)
– Maintaining oxygen status and blood pressure
– Treating other infections if they occur
• Timely treatment of Ebola VD is important but challenging because
the disease is difficult to diagnose clinically in the early stages of
infection. Because early symptoms, such as headache and fever,
are nonspecific to ebola viruses, cases of Ebola VD may be initially
misdiagnosed.

46. Treatment (2)
• However, if a person has the early symptoms of Ebola VD and there
is reason to believe that Ebola VD should be considered, the
patient should be isolated and public health professionals notified.
• Supportive therapy can continue with proper protective clothing
until samples from the patient are tested to confirm infection.
• Experimental treatments have been tested and proven effective in
animal models but have not yet been used in humans.

47. Risk Reduction Imperatives
• Reducing the risk of wildlife-to-human transmission
– Animals should be handled with gloves and other appropriate
protective clothing.
– Animal products (blood and meat) should be thoroughly cooked
before consumption.
• Reducing the risk of human-to-human transmission
– Use of appropriate personal protective equipment
– Regular hand washing is required after visiting patients in hospital, as
well as after taking care of patients at home.
• Outbreak containment measures including :
– Prompt and safe burial of the dead,
– identifying people who may have been in contact with someone
infected with Ebola, monitoring the health of contacts for 21 days
– Separating the healthy from the sick to prevent further spread
– Good hygiene and maintaining a clean environment.

48. • Barrier nursing techniques, to avoid contact with the blood or
secretions of an infected patient, include:
• wearing of protective clothing (such as masks, gloves,
gowns, and goggles)
• using infection-control measures (such as complete
equipment sterilization and routine use of disinfectant)
• isolating patients with Ebola from contact with unprotected
persons.
• If a patient with Ebola dies, direct contact with the body of the
deceased patient should be avoided.
• Proper cleaning and disposal of instruments, such as needles
and syringes, is also important. If instruments are not
disposable, they must be sterilized before being used again.
Prevention of infection (1)

49. If travelling to an area with known Ebola cases:
• Practice careful hygiene. Avoid contact with blood and body
fluids.
• Do not handle items that may have come in contact with an
infected person’s blood or body fluids.
• Avoid funeral or burial rituals that require handling the body of
someone who has died from Ebola.
• Avoid contact with bats and nonhuman primates or blood,
fluids, and raw meat prepared from these animals.
• Avoid hospitals where Ebola patients are being treated.
• After you return, monitor your health for 21 days and seek
medical care immediately if you develop symptoms of Ebola.
Prevention of infection(2)

50. Prevention and Management of
Occupational Exposure to EVD

51. Why is it so important?
• High rate of morbidity and mortality among
infected patients.
• Risk of human-to-human transmission.
• Lack of approved vaccine and therapeutics.
• Ebola virus disease in West Africa is
unprecedented in many ways, including the high
proportion of doctors, nurses, and other health
care workers who have been infected.

52. contd…
• Till 12th October 2014 427 health care workers have developed
the disease in the four affected countries of which 236 have
died.(as per WHO)
• Several factors for this high proportion of infected
that unprecedented number of medical staff have
been infected with Ebola during the current
outbreak.
– shortages of personal protective equipment.
– proper use of PPE.
– Doctor patients ratio is high in view of such a large
outbreak.
– medical staff to work in isolation wards far beyond the
number of hours recommended as safe.

53. What to Do?
• Recommended PPE should be worn by HCW
• upon entry into patient rooms or care areas.
• Upon exit from the patient room or care area.
• PPE should be carefully removed without contaminating
one’s eyes, mucous membranes, or clothing with
potentially infectious materials and either discarded.
• For re-useable PPE, cleaned and disinfected
according to the manufacturer's reprocessing
instructions and hospital policies.
• Hand hygiene should be performed immediately
after removal of PPE.

54. Health care provider to strictly follow:
• Use of personal protective equipment (PPE).
• Healthcare workers should wear disposable caps, water resistant gown, surgical
mask/ N95 respirator, face shield/ goggles, gloves, and shoe covers/boots.
• Vigilance on hand hygiene and proper donning/ removing of PPE is essential.
• Before exiting the room, dispose all disposable PPEs clinical waste. Non-
disposable items e.g. used boots should be decontaminated in designated places
• N95 respirator should be worn for managing patients presented with cough,
vomiting, diarrhoea, bleeding; or for aerosol-generating procedures such as
endotracheal intubation or cardiopulmonary resuscitation.
• Wear boots if environment is grossly contaminated with blood or body fluid.
• Wear double gloves when handle cases with haemorrhagic symptoms.

55. Monitoring and Management of Potentially
Exposed Personnel(1)
 HCP who develop respiratory symptoms or fever after an unprotected
exposure (i.e. not wearing recommended PPE at the time of contact) to a
patient with EVD should
• not report to work or immediately stop working
• notify their supervisor
• seek prompt medical evaluation
• comply with work exclusion until they are deemed no longer
infectious to others

56. Monitoring and Management of Potentially
Exposed Personnel (2)
– For asymptomatic HCP who had an unprotected exposure (i.e. not wearing
recommended PPE at the time of contact) to a patient with EVD :
• Consider exclusion from work for 21 days to monitor for
signs and symptoms of illness and fever
• HCP continuing to work while wearing a facemask should
be reminded that if caring for patients under airborne
precautions, to change the facemask every 4-6 hours

57. Cleaning , Disinfection and/or Sterilization of
patient-care equipment & linen: (1)
 If possible, use either disposable equipment or dedicated equipment (e.g.
stethoscopes, blood pressure cuffs and thermometers).
 If equipment needs to be shared among patients, clean and disinfect it
between each patient use.
 Reusable non-critical equipment (e.g. stethoscopes, blood pressure
cuffs, pulse oximeters, commodes, bedpans, walker, etc.) should be
dedicated to the use of the patient and should be cleaned and disinfected
before reuse with another patient.

58. Cleaning , Disinfection and/or Sterilization
of patient-care equipment & linen: (2)
 Single use devices should be discarded in hands-free waste
receptacle after use.
 Ensure that cleaning, disinfection and sterilization procedure are
followed consistently and correctly.
 Manage laundry, food service utensils in accordance with routine
procedures.

59. Laundry maintenance worker to practice :
• Use Standard Precautions
• Gloves and hand hygiene
• Impermeable Gown
• Mask
• Avoid aerosolization – do not shake
• Soiled linen should be placed in clearly-labelled, leak-proof bags or buckets at
the site of use and the container surfaces should be disinfected (using an
effective disinfectant) before removal from the isolation room/area.
• If there is any solid excrement such as faeces or vomit, scrap off carefully using a
flat firm object and flush it down the toilet or in the sluice before linen is placed in
its container.

60. Collection and handling of laboratory specimens
: precautions (1)
• All specimens should be regarded as potentially infectious&
follow standard precautions.
• Ensure that HCWs who collect specimens or transport
wear appropriate PPE. & are trained in safe handling
practices and spill decontamination procedures.
• Ensure that health-care facility laboratories adhere to
appropriate biosafety practices and transport requirements
according to the type of organism being handled.

61. Collection and handling of laboratory
specimens : precautions (2)
• Deliver all specimens as per guidelines
• Label the suspected ARI specimens of potential concern
clearly on the accompanying request form.
• Notify the laboratory as soon as possible that the specimen
is being transported.

62. For those assistance or treating sick family
members in their home
• Always seek treatment at your nearest health facility. Isolation and early treatment
increase your chance of survival and may prevent spread to your family and
community.
• If a person with Ebola remains at home, provide dedicated room, utensils and
clothing. Wash these items with water and detergent or with disinfectant separately
from the rest of the household.
• Provide the sick person with plenty of drinks, such as water, soup, tea and locally
available beverages. Alcohol should be avoided.
• Assign one person to take care of the individual affected.& he/she should be self
monitoring its health specially fever etc.

63. For those assistance or treating sick family
members in their home
• Family or community members who have fully recovered from Ebola will not get it
again and can safely provide care to others who are sick.
• Always provide care, after wearing complete PPE. Don't touch the person with
Ebola or their bodily fluids without protective equipment. Bodily fluids include
stool, vomit, breast milk, semen and blood.
• Wash your hands frequently with soap and water.

64. If the use of sharp objects cannot be avoided,
ensure the following precautions are observed:
• Never replace the cap on a used needle.
• Never direct the point of a used needle towards any part of the body.
• Do not remove used needles from disposable syringes by hand, and do
not bend, break or otherwise manipulate used needles by hand.
• Dispose of syringes, needles, scalpel blades and other sharp objects in
appropriate, puncture-resistant containers.
• Ensure that puncture-resistant containers for sharps objects are placed
as close as possible to the immediate area where the objects are being
used (‘point of use’) to limit the distance between use and disposal, and
ensure the containers remain upright at all times.

65. Injection safety contd….
• If the sharps container is far, never carry sharps in your hand but place
them all in a tray.
• Ensure that the puncture-resistant containers are securely sealed with a
lid and replaced when 3/4 full.
• Ensure the containers are placed in an area that is not easily accessible
by visitors, particularly children (e.g. containers should not be placed on
floors, or on the lower shelves of trolleys in areas where children might
gain access).

66. Prevention of injuries from needles and other sharp
instruments
• Use care when handling, using, cleaning, and
disposing of needles, scalpels, and other sharps.
• Do not bend, break, or otherwise manipulate used
needles, scalpels, or other sharp instruments.
• Do not recap needles.
• Keep a sharps container nearby when giving injections.
Discard single-use needles and syringes immediately
after use and directly into the sharps container, without
recapping and without passing to another person.
• Close, seal, and send sharps containers for
incineration before they are completely full.

67. Safety Needles
• Use needles with vacuum tubes and
safety needles.
• Conduct blood draw in dedicated
space.
• Avoid crowded areas or pathways.
• Dispose of needles and syringes in
puncture-proof containers designed for
this.
• Use needle destroyer.

68. Accidental spills of potentially contaminated
material : management
• The area should be evacuated and secured. Let aerosols settle for a
minimum of 30 minutes.
• cover with absorbent paper towels,
• liberally covered with disinfectant 1% sodium hypochlorite, and then left for
15 minutes before being wiped up.
• Remove of the initial material, the disinfection process should be repeated.
• Individuals attending to this task should wear complete PPE (PAPRs or other
approved respirators (e.g., N95, N100) ). should be considered for those
involved in the clean-up activity.
• Disposable gloves, impermeable gowns and protective eye wear are to be
removed immediately after completion of the process, placed in an
autoclave bag, and sterilized prior to disposal

69. Steps After Contaminated
Needle Prick/Blood Exposure
• Allow site to bleed
• Cuts to be washed with plenty of soap and running water
• Splashes into nose, mouth, skin to be flushed with water
• Eyes to be irrigated with clean water or saline
• Pricked finger should not be put into mouth (reflex)

70. contd…
• Do not squeeze blood from wound, this causes trauma and inflammation
–increases the risk of transmission
• Do not use bleach , alcohol, betadine or iodine, which may be caustic and
cause trauma
• Report immediately to the appropriate authority as emergency e.g.
biosafety officer

71. Post-mortem examinations
• Post-mortem examination should be limited to essential evaluations and
performed by trained personnel.
• Personnel should use PPE including eye protection, mask (a particulate respirator
or a PAPR if performing internal autopsy), double gloves and disposable
impermeable gowns.
• Specimens should be placed in clearly-labelled, non-breakable, leak-proof
containers and delivered directly to designated laboratory as per procedures.
• All external surfaces of specimen containers should be thoroughly disinfected
prior to transport.
• Tissue or body fluids for disposal should be carefully placed in clearly marked,
sealed containers for incineration

72. Crew members
• on a flight with a passenger who is ill with a /fever, jaundice, and/or bleeding
• and who is traveling from an area in which Ebola cases have been reported
should follow these precautions:
• Keep the sick person separated from close contact with others as much as
possible.
• Provide the sick passenger with a surgical mask (if the passenger can tolerate
wearing one) to reduce the number of droplets expelled into the air by talking,
sneezing, o r coughing.
• Tissues can be given to those who cannot tolerate a mask.
• .

73. Crew members
• Personnel should wear disposable gloves for direct contact with blood or other
body fluids (see IATA‘s Guidelines for Suspected Communicable Diseases ).
• Quarantine Station any ill passengers who meet specified criteria
• The ill passenger should be reported before arrival or as soon as the illness is
noted. Quarantine officials will help arrange for medical assistance to be
available when the airplane lands and will work with the airline, state and local
health
• department officials, and APHO to assist with medical transportation of the
patient upon arrival, disease control and containment measures, passenger
and crew notification, surveillance activities, and airline disinfection
procedures.
• .

74. Contacts - Information for those who have
had close contact with a person with
Ebola
• If you have touched or been in close contact with someone with Ebola or attended a
funeral of someone who has died of Ebola you may have been exposed to the disease.
Contacts of people with Ebola are those who have:
- Slept in the same household with a person with Ebola
- Touched a person with Ebola (alive or dead)
- Had sexual contact with a person with Ebola
- Touched the blood or bodily fluids of a person with Ebola (alive or
dead)
- Touched the personal belongings of a person with Ebola, including
their clothes, towels and bed linen
- Breastfed by a woman with Ebola
- Breastfed or wet nursed a baby with Ebola

75. For those who have had close contact with
a person with Ebola : what to do
• you should closely monitor you and your family’s health and stay close to your
home.
• Health workers may ask you to report the status of your health or visit you every
day for 30 days.
• Minimize close contact with other family members. Symptoms for Ebola can
appear 2 - 21 days after being exposed to the disease.
• You cannot spread Ebola disease until symptoms like sudden high fever and
headache appear.
• If you or a family member falls sick with sudden high fever, immediately contact
your local health facility for treatment.

76. Key messages for (IPC) to be followed in health
care settings
• Strengthen and carefully apply standard precautions when providing
care to ALL patients regardless of the signs and symptoms they present
with.
• Isolate suspected or confirmed hemorrhagic fever (HF) cases in single
isolation rooms or cohort them in specific confined areas while rigorously
keeping suspected and confirmed cases separate.
• Assure restricted access to these areas and dedicated equipment.
• Exclusively assign clinical and non-clinical personnel to HF patient care
areas.
• Ensure that prior to entering the patient isolation rooms/areas, all visitors
and health-care workers rigorously use personal protective equipment
(PPE) and perform hand hygiene as indicated in this document.

77. Key messages for (IPC) to be followed in
health care settings
• PPE should include at least: gloves, gown, boots/closed shoes with
overshoes (and mask and eye protection for splashes).
• Ensure safety of injections and phlebotomy procedures and
management of sharps.
• Ensure regular and rigorous environmental cleaning, decontamination
of surfaces and equipment and management of soiled linen and of
waste.
• Ensure safe processing of laboratory samples from suspected or
confirmed patients with HF.

79. Key Interventions
• Surveillance including those at Point of Entries
• Contact tracing
• Laboratory Support
• Case management in identified isolation
facilities.
• Infection prevention and control practices
• Safe burials .
• Community engagement.

80. To conclude
• There is Risk of Importation to India.
• Only spread by direct contact with blood and
body fluids; not airborne.
• Only infectious when symptomatic.
• Previous outbreaks have been contained.
• Unlikely to see widespread onward transmission
of Ebola virus disease following an imported case.
• Community engagement is key to successfully
containing outbreaks.

81. MOLECULAR STRUCTURE
Morphology under electron microscope
– Filamentous, enveloped ssRNA virus
– Approx. 19 kb in length (1 kb = 1000 RNA
bases/nucleotides) or 60-80 nm in diameter
– Single-stranded, linear, non-segmented
– Negative-sense RNA (encoded in a 3’ to 5’ direction)
– Appears to have “spikes” due to glycoprotein on
Outside membrane