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Ebola the deadly african virus

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Ebola the deadly african virus

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Ebola the deadly african virus

  1. 1. The Deadly African Virus
  2. 2. By Dr.Ashraf Eladawy Consultant Chest Physician TB TEAM EXPERT – WHO Mansoura -Egypt
  3. 3. 4
  4. 4. 7
  5. 5. 8
  6. 6. 2014
  7. 7. EBOLA OUTBREAK 2014
  8. 8. 2014
  9. 9. Saudi Arabia Bans Haj Pilgrims From Ebola Hit Countries- August 4, 2014
  10. 10. The world's worst outbreak of Ebola that has killed nearly 1,000 people in West Africa represents an international public health emergency 8 August 2014
  11. 11. Ebola Virus Disease
  12. 12. Ebola: WHO declares the epidemic as global emergency US health authorities had admitted that Ebola's spread beyond west Africa was inevitable. Even medical charity Doctors Without Borders had warned that the deadly virus was now "out of control" with more than 60 outbreak hotspots
  13. 13. Egypt hospitals on alert for Ebola Aug. 09, 2014
  14. 14. من ناحيتها أعلنت وزارة الصحة والسكان خلو مصر من أية حالات مشتبهة أو مؤكدة لمرض "إيبولا" حتى الآن، مشيرة إلى اتخاذ قطاع الشئون الوقائية والمتوطنة عدد من الإجراءات الوقائية في إطار المتابعة اليومية للموقف الوبائي العالمي للمرض وبدأت سلطات الحجر الصحي في مطار القاهرة تشديد الإجراءات الوقائية للركاب القادمين من دول غرب إفريقيا، عن طريق مباشر أو غير مباشر وأكد مدير الحجر الصحي في مطار القاهرة أن الاجراءات التى سيتم اتخاذها تتضمن تحرير بطاقات صحية للقادمين من هذه الدول تشمل كافة البيانات عنهم، وإرسالها للمديريات الصحية في المحافظات لمتابعة الراكب لمد 21 يوما بعد وصوله، الحميات
  15. 15.  In the case of a suspected infection, a patient would be transported to the Abasseya Fever hospital, which has been equipped with all equipments required to handle such cases  Egypt’s Health Ministry has warned Egyptians from travelling to West Africa, especially Sierra Leone, Nigeria and Liberia where several cases of Ebola have been reported.
  16. 16. استعدادات مكثفة بالدقهلية لمواجهة موسم إصابات الجهاز التنفسى والإيبولا 27.08.2014
  17. 17. قال اللواء عمر الشوادفي محافظ الدقهلية، إن مديرية الصحة بالدقهلية اتخذت كافة الإجراءات سواء من تدريب أو توفير مستلزمات أو مطبوعات لمواجهة موسم إصابات الجهاز التنفسي و الايبولا فى
  18. 18. Definition  Ebola virus disease (formerly known as Ebola hemorrhagic fever) is: – A disease caused by the Ebola virus – Is severe- fatality rate 90% – Affects human and non human primates (such as monkeys, gorillas, and chimpanzees)
  19. 19. History of Ebola virus  Ebola first appeared in 1976 in two simultaneous outbreaks.  In Nzara , small town in southern Sudan.  In Yambuku, in the Democratic Republic of Congo (Zaire) , The latter was a village situated near the Ebola River, from which the disease takes its name
  20. 20. Zaire = Democratic republic of congo
  21. 21. AlvinChew slideshare presentation alvinworks2006@yahoo.com
  22. 22. History of Ebola virus Ebola first appeared in 1976 in 2 simultaneous outbreaks, first in Nzara , in south of Sudan which infected over 284 people, with a mortality rate of 53%. Another out break occurred in Yambuku in Democratic Republic of Congo , which infected 318 people with highest mortality rate of 88% .
  23. 23. Ebola Outbreaks  24 outbreaks reported by WHO from 1976 till 2012 . No case reported out of Africa till 2012 .  Epidemics of Ebola virus have occurred mainly in African countries: 1. Democratic Republic of Congo ( Zaire ) 2. Sudan 3. Gabon 4. Uganda 5. Côte d’Ivoire ( one case in 1994) 6. South Africa ( one case in 1996 )
  24. 24. Natural Habitat = Africa  Zaire (Democratic Republic of the Congo)  Sudan  Gabon  Ivory Coast  Uganda  Republic of the Congo (not the DRC) Ivory Coast Gabon Congo DRC Sudan Uganda
  25. 25. Cases of Ebola Hemorrhagic Fever in Africa, 1976 - 2008 Country Town Cases Deaths Species Year Dem. Rep. of Congo Yambuku 318 280 Ezaire 1976 Sudan Nzara 284 151 Esudan 1976 Dem. Rep. Tandala 1 1 Ezaire 1977 of Congo Sudan Nzara 34 22 Esudan 1979 Gabon Mekouka 52 31 Ezaire 1994 Ivory Coast Tai Forest 1 0 EIvoryCoa st 1994 Dem. Rep. of Congo Kikwit 315 250 Ezaire 1995 Gabon Mayibout 37 21 Ezaire 1996
  26. 26. Gabon Booue 60 45 Ezaire 1996 South Africa Johannesburg 2 1 Ezaire 1996 Uganda Gulu 425 224 Esudan 2000 Gabon Libreville 65 53 Ezaire 2001 Republic of Not 57 43 Ezaire 2001 Congo specified Republic of Congo Mbomo 143 128 Ezaire 2002 Republic of Congo Mbomo 35 29 Ezaire 2003 Sudan Yambio 17 7 Esudan 2004 Dem. Rep. of Congo Luebo 264 187 Ezaire 2007 Uganda Bundibugyo 149 37 Ebundi 2007 Dem. Rep. of Congo Luebo 32 15 Ezaire 2008
  27. 27. AlvinChew slideshare presentation alvinworks2006@yahoo.com
  28. 28. 2014 Ebola Outbreak in West Africa The 2014 Ebola outbreak is one of the largest Ebola outbreaks in history and the first in West Africa. It is affecting five countries in West Africa: 1. Guinea 2. Liberia 3. Sierra Leone 4. Nigeria 5. DRC
  29. 29. 2014 Ebola Outbreak in West Africa - Outbreak Distribution Map
  30. 30. 2014 Ebola Outbreak in West Africa - Outbreak Distribution Map
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  32. 32. WHO , August 28 , 2014 The latest World Health Organization data on 2014 Ebola outbreak in West Africa shows 3,069 probable and confirmed cases and 1,552 deaths. The number of cases continues to accelerate, with 40 percent of the total cases occurring in the last 21 days. It is the deadliest outbreak of Ebola in history.
  33. 33. The total impact of previous recorded outbreaks — from 1976 to 2013 — included 2,357 cases and 1,548 deaths, according to the CDC. The WHO predicts the disease is going to continue to rip through Africa for another six to nine months, though the organization has vowed to stop the outbreak within that time.
  34. 34. The assessment came as the W.H.O. presented what it called a road map for stopping the transmission of Ebola within six to nine months. The plans are likely to cost nearly half a billion dollars over the next six months. Though the road map aims to stop the epidemic in that time frame, “We have to be realistic that there is uncertainty” about such targets. Bruce Aylward, an assistant director general of the health organization
  35. 35. Ebola Could Eventually Afflict More Than 20,000, W.H.O. Says  The World Health Organization said that the Ebola epidemic was still accelerating and could afflict more than 20,000 people — almost seven times the current number of reported cases — before it could be brought under control WHO , August 28 , 2014
  36. 36. Senegal confirms its first Ebola case, a university student from Guinea 29 August 2014
  37. 37. Senegalese health minister Awa Marie confirm the frist case of Ebola in Senegal on Aug. 29 in Dakar
  38. 38. Senegal urgently needs supplies to stop Ebola, WHO says  The effort to contain Ebola in Senegal is “a top priority emergency,” WHO said  The government continued tracing everyone who came in contact with a Guinean student who has tested positive for the deadly disease in the capital, Dakar.  Senegal faces an “urgent need” for support and supplies including hygiene kits and personal protective equipment for health workers, the WHO said .
  39. 39. Genus of Ebola Virus
  40. 40. 5 Species of ebola virus 1. Bundibugyo (Uganda) 2. Zaire ( Democratic Republic of Congo) 3. Sudan 4. Côte d’Ivoire (Taï Forest ebolavirus ) 5. Reston
  41. 41.  Bundibugyo , Zaire and Sudan Ebola virus species are associated large Ebola virus disease outbreaks in Africa with high case fatality ratio (25–90%) .  Reston ebolavirus (RESTV) and Taï Forest ebolavirus (TAFV) , formerly Côte d’Ivoire have not associated with EVD in Africa .
  42. 42. The Reston ebolavirus (RESTV ), 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. , has only caused asymptomatic illness Reston ebolavirus , has caused disease in nonhuman primates, but not in humans.
  43. 43. 2014 Ebola Outbreak in West Africa  Genetic analysis of the virus indicates that it is closely related (97% identical) to variants of Ebola virus (species Zaire ebolavirus) identified earlier in the Democratic Republic of the Congo and Gabon
  44. 44. Natural host of Ebola virus  In Africa, Fruit bats of the Pteropodidae family are considered to be the possible natural host of the Ebola virus
  45. 45.  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.
  46. 46.  Scientists now believe that bats are the natural reservoir for the virus, and that apes and humans catch it from eating food that bats have drooled or defecated on, or by coming in contact with surfaces covered in infected bat droppings and then touching their eyes or mouths.  The current outbreak seems to have started in a village near Guéckédou, Guinea, where bat hunting is common, according to Doctors Without Borders.
  47. 47. The infection of human cases with Ebola virus through the handling of infected chimpanzees, gorillas, and forest antelopes – both dead and alive – has been documented in Côte d'Ivoire, the Republic of Congo and Gabon. The transmission of the Ebola Reston strain through the handling of cynomolgus monkeys has also been reported.
  48. 48. The manner in which the virus first appears in a human at the start of an outbreak is unknown. However, researchers have hypothesized that the first patient becomes infected through contact with an infected animal . Researchers believe that the virus is zoonotic (animal-borne) with fruit bats being the most likely natural reservoir.
  49. 49. Bats are strongly implicated as both reservoirs and hosts for the ebolavirus. Initial infections in humans result from contact with an infected bat or other wild animal The Ebola virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
  50. 50.  Host immune responses to Ebola virus and cell damage due to direct infection of monocytes and macrophages cause the release of cytokines associated with inflammation and fever.  Infection of endothelial cells also induces a cytopathic effect and damage to the endothelial barrier that, together with cytokine effects, leads to the loss of vascular integrity.
  51. 51.  The cytopathic effect, from infection in the endothelial cells, results in a loss of vascular integrity  Damage to the liver leads to coagulopathy 08/21/2014 Dr. Vaibhav V. Rajhans 85
  52. 52. Infection And The Immune Response Instead of hiding from your immune system Ebola Virus (EBOV) infects cells of your immune system first Once the virus infects your immune cells and begins to replicate, it evolves to have an affinity for other cell types, especially liver cells.
  53. 53. Pathogenic Mechanisms • EBOV has two main, and complementary, pathogenic mechanisms that make it so deadly:  It turns on the inflammatory response full-blast. This results in increased vascular permeability, hemorrhage, shock, and ultimately, death.  It turns off the activation of virus-specific immune responses so you get little-to-no anti-viral immunity to control the replication of the virus inside your body.
  54. 54. Ebola Infection Domino Effect  EBOV infects Dendritic Cells , monocytes, and macrophages , and also activates neutrophils. These are all cells belonging to your early or “innate” immune system, which is your front-line defense against foreign invaders.  These events cause the release of massive amounts of pro-inflammatory cytokines such as TNFa, which increase vascular permeability, fluid leakage, and shock. This effect is known as “cytokine storm”.
  55. 55. Tissue Factor is also produced, which disrupts normal blood clotting and contributes to hemorrhaging.  Virus replication escalates in the infected cells  In the infected cells, the production of interferon-gamma (IFNg) is turned off. Downstream interactions of DCs and MO with lymphocytes (T cells and B cells) to initiate an anti-viral immune response, which are dependent on IFNg, are disrupted.
  56. 56. 5 The maturation of DCs into functional antigen-presenting cells is inhibited, which, along with the decrease in IFNg, blocks activation of T cells and B cells preventing development of virus-specific immunity. 6 Virus replication is rampant in infected cells resulting in rapid spread internally, high viral loads, and nothing to keep the virus in check
  57. 57. 7 The virus spreads to other cell types, in particular liver cells, eventually leading to liver failure, increasing the potential for hemorrhaging. 8 Once symptoms appear, death typically occurs within 7-14 days. If the patient survives, recovery can be a very long and difficult process.
  58. 58. Transmission of EVD  Ebola is introduced into the human population through 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, monkeys, forest antelope, porcupines and fruit bats found ill or dead or in the rainforest.
  59. 59. African brush-tailed porcupine sold for meat in Cameroon
  60. 60. Transmission of EVD Generally, a person must come into contact with an animal that has Ebola and it can then spread within the community from human to human.
  61. 61. Transmission of EVD In the 2014 Ebola outbreak, nearly all of the cases of EVD are a result of human- to-human transmission (H2H) . Person-to-person transmission is the means by which outbreaks and epidemics progress
  62. 62. Transmission of EVD  Ebola spreads in the community through human-to-human transmission .  Infection result 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.
  63. 63. When an infection does occur in humans, the virus can be spread in several ways to others. The virus is spread through direct contact (through broken skin or mucous membranes) with 1. A sick person's blood or body fluids (urine, saliva, feces, vomit, and semen) 2. Objects (such as needles , soiled clothing, bed linen ) that have been contaminated with infected body fluids 3. Infected animals
  64. 64. AlvinChew slideshare presentation alvinworks2006@yahoo.com
  65. 65. Ebola is not spread through the air or by water or, in general, by food  However, in Africa, Ebola may be spread as a result of hunting, processing and consuming infected animals (e.g. bushmeat ).
  66. 66. Transmission of EVD Additional transmission has occurred in communities during funerals and burial rituals. Burial ceremonies in which mourners have direct contact with the body of the deceased person have played a role in the transmission of Ebola.
  67. 67. Persons who have died of Ebola must be handled using strong protective clothing and gloves and must be buried immediately. WHO advises that the deceased be handled and buried by trained case management professionals, who are equipped to properly bury the dead.
  68. 68. During outbreaks of Ebola HF, the disease can spread quickly within health care settings. Exposure to ebolaviruses can occur in health care settings where hospital staff are  Not wearing appropriate PPE (personal protective equipments ) or  Not properly applying infection prevention and control measures when caring for the patients.
  69. 69. Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. Healthcare providers at all levels of the health system – hospitals, clinics, and health posts – should be briefed on the nature of the disease and how it is transmitted, and strictly follow recommended infection control precautions
  70. 70. WHO does not advise families or communities to care for individuals who may present with symptoms of Ebola virus disease in their homes.  Rather, isolated , seek treatment in a hospital .
  71. 71. Proper Clothing
  72. 72. Medical personnel aiding in ZAIRE
  73. 73. VICTIM OF EBOLA ZAIRE
  74. 74. Ebola is extremely infectious, because a very small amount can cause illness , so people who are infected are highly likely to get sick. But it's not highly contagious. You are not likely to catch Ebola just by being in proximity with someone who has the virus; it is not airborne, like the flu or respiratory viruses such as SARS. Instead, Ebola spreads through direct contact with bodily fluids.
  75. 75. Who is most at risk?  During an Ebola outbreak, those at higher risk of infection are:  Health care workers  Family members or others in close contact with infected people  Mourners who have direct contact with the bodies of the deceased as part of burial ceremonies.
  76. 76. Unprecedented number of medical staff infected with Ebola The outbreak of Ebola virus disease in west Africa is unprecedented , including the high proportion of doctors, nurses, and other health care workers who have been infected. To date, more than 240 health care workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died. Situation assessment - 25 August 2014
  77. 77. Incubation period The incubation period from time of infection with the Ebola virus to appearance of symptoms associated with the disease is as short as 2 days to as long as 21 days. Symptoms may appear any where from 2 to 21 days after exposure to ebolavirus, although 8-10 days is most common.  A person infected with Ebola virus is not contagious until symptoms appear.
  78. 78. Ebola Virus Disease
  79. 79. Ebola Virus Disease
  80. 80. Ebola Virus Disease
  81. 81. EBOLA VICTIM
  82. 82. Diagnosis Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests: 1) Antibody-capture enzyme-linked immunosorbent assay (ELISA) 2) Antigen detection tests 3) Serum neutralization test 4) Reverse transcriptase polymerase chain reaction (RT-PCR) assay 5) Electron microscopy 6) Virus isolation by cell culture.
  83. 83.  Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.  People are infectious as long as their blood and secretions contain the virus..  For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home
  84. 84. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.
  85. 85. Treatment No specific treatment is available .  Standard treatment for Ebola HF is still limited to supportive therapy consists of :  Balancing the patient’s fluids and electrolytes Maintaining their oxygen status and blood pressure Treating them for any complicating infections .
  86. 86. Vaccine No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use. Currently, there is no licensed medicine or vaccine for Ebola virus disease, but several products are under development
  87. 87. Mapp Biopharmaceutical’s ZMapp  An experimental treatment is a combination or cocktail of three monoclonal antibodies that is designed to bind to the protein of the Ebola virus, neutralizing the virus so it can’t do any further damage.
  88. 88. WHO’s travel advice The risk of Ebola infection for travellers is very low since person‐to‐person transmission results from direct contact with the body fluids or secretions of an infected patient. WHO does not recommend any travel or trade restrictions be applied except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD.
  89. 89. The risk of a tourist or businessman/woman becoming infected with Ebola virus during a visit to the affected areas and developing disease after returning is extremely low. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animal, all of which are unlikely exposures for the average traveller. In any event, tourists are advised to avoid all such contacts.
  90. 90. Transmission to health-care workers has been reported when appropriate infection control measures have not been observed.
  91. 91. It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. It is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times.
  92. 92. Close physical contact with Ebola patients should be avoided.
  93. 93. Personal protective equipment should be worn when taking care of ill patients .  PPE should include at least: i. Gloves, ii. Impermeable gown, iii. Boots/closed shoes with overshoes iv. Mask v. Goggles or face shields.
  94. 94. Other key precautions are safe injection and phlebotomy procedures, including safe management of sharps, regular and rigorous environmental cleaning, decontamination of surfaces and equipment, and management of soiled linen and of waste. In addition, it is important to ensure safe processing of laboratory samples from suspected or confirmed patients with EDV
  95. 95.  Isolating patients with suspected or confirmed Ebola virus disease in single isolation rooms is recommended.  Where isolation rooms are not available, it is important to assign designated areas, separate from other patients, for suspected and confirmed cases.  In these designated areas, suspect and confirmed cases should also be separate  Access to these areas should be restricted
  96. 96. Stopping visitor access to patients infected with EVD is preferred. If this is not possible, access should be given only to those individuals who are necessary for the patient’s well‐being and care, such as a child’s parent
  97. 97. People who have died from Ebola should only be handled using appropriate protective equipment and should be buried immediately by public health professionals who are trained in safe burial procedures. it's important to avoid direct contact with the body of an Ebola victim who has died
  98. 98. Liberian health workers on the way to bury a woman who died of the Ebola virus
  99. 99. For healthcare workers in Africa, who are most likely to encounter cases of Ebola, prevention focuses on being able to recognize cases of the disease when they appear, as well as using barrier isolation techniques to avoid direct contact with infected people.  improved hospital infection control crucial
  100. 100. Egypt is Ebola free, but not far from the outbreak
  101. 101. Clinicians caring for travellers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease.
  102. 102. Panic is our enemy Knowledge is our friend Preparation is our best line of defence

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