DR.SATTI MOHAMMED SALEH INFECTIOUS DISEASE PHYSICIAN INFECTION CONTROL DIRECTOR MEEQAT HOSPITAL CBAHI SIT MEMBER Meeqat General Hospital Madinah

1. DR.SATTI MOHAMMED SALEH
INFECTIOUS DISEASE PHYSICIAN
INFECTION CONTROL DIRECTOR
MEEQAT HOSPITAL
CBAHI SIT MEMBER
Meeqat General Hospital Madinah

3. CHANGING PATTERN OF INFECTIOUS
DISEASES EPIDIMIOLOGY
Spread to new group
Re emerging of some diseases
Resurgent epidemics
Disappearance of same diseases
Appearance of new infectious
disease

4. Determination of change
Changes in susceptibility to
infectious disease
Increase opportunities for
infection
Rapid adaptation of microbial
world

5. What are viral hemorrhagic
fevers?
(VHFs) refer to a group of illnesses that
are caused by several distinct families
of viruses. In general, the term "viral
hemorrhagic fever" is used to describe
a severe multisystem syndrome
(multisystem in that multiple organ
systems in the body are affected).
Characteristically, the overall vascular
system is damaged, and the body's
ability to regulate itself is impaired

6. ETIOLOGICAL VIRUSDISEASESMODE OF
TRANSMISSION
Yellow fever
Dengue types 1-4
Chikunguny a rift
valley fever
Yellow fever
Dengue fever
Chikunguny a
hemorrhagic fever
Mosquito borne
Congo-Crimean
hemorrhagic fever
kyasanur forest
disease Omsik
hemorrhagic fever
Crimean hemorrhagic
fever kyasanur forest
disease a Omsk
hemorrhagic disease
Tick borne
Junin
Machupo
Lassa
Argentine hemorrhagic fever
Bolivian hemorrhagic
fever- Lassa fever
Zoonotic
Hanta an
Marburg
Ebola
Korean hemorrhagic
fever
Marburg virus disease
Ebola virus disease
Unknown

7. Filoviridae
(Ebola, Marburg)
Arenaviridae
(Lassa, Junin, Machupo, Guanarito)
Bunyaviridae
(CCHF, RVF,
Hantaviruses)
Viral Haemorrhagic Fevers
Flaviviridae
(dengue, yellow fever,
TBE encephalitides)
Enveloped
RNA viruses

8. Ebola hemorrhagic fever
(Ebola HF) is one of
numerous Viral Hemorrhagic
Fevers. It is a severe, often
fatal disease in humans and
nonhuman primates (such as
monkeys, gorillas, and
chimpanzees).

10. 3Genere
1- Ebola Virus
2- Marburgvirus
3- Cuevasirus ( NEW

11. Ebola Virus Genus Consists
of 5 species
1- Zaire
2- Sudan
3- Reston
4- Taiforest
5- Bundibugyo( New)

12. reservoir
The natural host of ebola viruses, and the
manner in which transmission of the virus
to humans occurs, remain unknown. This
makes risk assessment in endemic areas
difficult. With the exception of several
laboratory contamination cases (one in
England and two in Russia), all cases of
human illness or death have occurred in
Africa; no case has been reported in the
United States.

14. All filoviruses are classified
as :
 All filoviruses are classified as :
 Category A select agent pathogens in
USA
 1- Easily transmitted between Humans
 2- Cause High Mortality ( 40-90%)
 3- Potential for Major Public Health
Impact
 4- High public panic and disruption
 5- Concern for use as Bioterror weapon

15. Need BSL for LAB to provide
highest level of protection for
both lab workers and
environment

16. Epidemiology :
 MURBURG HF ( first filovirus ) In
Germany and Yugoslavia 1967
 From primates imported from
Uganda 31 cases, 23% mortality
 Largest outbreak of MURBURG in
Angola 2005, 250 cases 90%
mortality

17. large outbreak
 Ebola HF first 2 large outbreak
simultaneously 1976
 Democratic Republic of
Congo
 Southern Sudan
 Caused by 2 separate
species ;
 Zaire ( EBOV) and Sudan ( SUDV)

18. Other 3 species of EBOLA : (
TAI, RESTON, BUNDIBUGYO
 )
 Occurred less frequently
 TAI only single non fatal infection )
 (AUTOPSY OF DEAD CHIMPANZEES)

19.  A host of similar species is probably
associated with Reston virus, which
was isolated from infected
cynomolgous monkeys imported to
the United States and Italy from the
Philippines. Several workers in the
Philippines and in US holding facility
outbreaks became infected with the
virus, but did not become ill.

20. Transmission and
Pathogenesis and Pathology
 Spread by close contact with sick
patients
 Virus containing bodily fluids
Includes
 *Blood * Semen
 * Vomitus *Breast milk
 *Saliva *Tears
 *Stool

21. Transmission Requires
 Close contact with blood, body
fluid and mucous Membranes
Exposure
 No true Aerosol transmission
 No transmission in
asymptomatic patients during
incubation Period

22. Severe Diseases
Attributed to
 :
1- Rapid Viral Replication
2- Host immune
suppression
3- Vascular Dysfunction

23. Incubation period
 2-21 days.
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26. Case definition-WHO/CDC
Anyone presenting with fever and signs of bleeding such as:
 • Bleeding of the gums
 • Bleeding from the nose
 • Red eyes
 • Bleeding into the skin (purple coloured patches in the skin)
 • Bloody or dark stools
 • Vomiting blood
 • Other unexplained signs of bleeding
 Whether or not there is a history of contact with a suspected
case of EHF.
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28. OR Anyone living or deceased with:
 Contact with a suspected case of EHF AND
 A history of fever, with or without signs of bleeding.
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29.  OR
 Any unexplained death in an area with suspected
cases of EHF.
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30. Lab findings
 Leucopenia.
 Thropocytopenia.
 Elevated liver enzymes.
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31. Lab diagnosis
 Specific antigen detection.
 Viral gene detection.
 Antibodies detection (IgM for recent infection).
 Viral isolation (BSL-4 Lab.).
 Non-invasive methods of detection (saliva and urine
sample).
 Postmortem by immunohistochemical exam. Of
skin or autopsy specimen.
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32. Therapy
 No specific ttt
 No vaccine
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33. Treatment : Supportive
Fluid management
Blood products and management of DIC
Oxygenation and ventilation
Nutrition
No anti viral available
Future management

34. Containment
 Isolate suspected cases from other patients.
 Tracing and follow up people exposed to Ebola
cases.
 Health staff Orientation and using PPE.
 Health staff Precaution for invasive technique and
body secretions.
 Inform public about disease nature and burial of
deceased.
 Strict surveillance of contacts.
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35. Patient Placement
Single patient room (containing a
private bathroom) with the door closed
Facilities should maintain a log of all
persons entering the patient's room
Consider posting personnel at the
patient’s door to ensure appropriate and
consistent use of PPE by all persons
entering the patient room

37. Personal Protective
Equipment (PPE)
All persons entering the patient room should
wear at least:
Gloves
Gown (fluid resistant or impermeable)
Eye protection (goggles or face shield)
Facemask
Additional PPE might be required in certain
situations (e.g., copious amounts of blood,
other body fluids, vomit, or feces present in the
environment), including but not limited to:
Double gloving
Disposable shoe covers
Leg coverings

39. Challenges
 Additional diagnostic tools.
 Ecological investigations and possible reservoirs.
 Monitor suspected cases to determine disease
incidence.
 Natural reservoirs and how virus spread.
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41. 1/6//2015
27055
All countries
TOTAL NUMBER
L
1/6/2015
11147All countries
DEATHS
1/6/201514981CONFIRMED
Number of cases
cumulative

42. THANK YOU
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