This document summarizes a seminar presentation on Ebola virus disease (EVD). It provides an overview of EVD outbreaks, case definitions, epidemiology, clinical presentation, diagnosis, treatment, and control/prevention. Key points include: EVD is caused by infection with Ebola virus and transmitted through contact with infected body fluids; symptoms range from fever and fatigue to vomiting and hemorrhaging; diagnosis involves virus detection through antigen/antibody tests or PCR; treatment is supportive care as no vaccine currently exists; control relies on isolation, contact tracing, and barrier precautions.

1. A Seminar
on
Ebola Virus Disease
Presenters: Dr. Joymati Oinam
Dr. Shanthosh Priyan S
Moderator: Dr. P. Romola Devi
Associate Professor

2. OUTLINE
1. Introduction
2. History of past outbreaks
3. Overview of current outbreak
4. Case definition & Exposure risk levels
5. Epidemiology
 Classification of Ebola virus
 Reservoir and transmission to humans
 Pathogenesis
 Clinical presentation and prognosis
6. Diagnosis
7. Treatment
8. Case management
9. Control and Prevention
10. Guidelines for prevention
11. Conclusion

3. INTRODUCTION
• Ebola virus disease (also known as Ebola hemorrhagic
fever) is an acute, severe, often-fatal disease caused by
infection with a species of Ebola virus.
• The virus is transmitted to people from wild animals and
spreads in the human population through human-to-
human transmission.
• The average EVD case fatality rate is around - 50%
(25% to 90% )

4. • Ebola virus disease (EVD) first appeared in 1976 in 2
simultaneous outbreaks -
 Nzara, Sudan, and
 Yambuku, Zaire (Democratic Republic of Congo)
near the Ebola River.
• Since then, outbreaks have appeared sporadically.
• No cure & treatment is largely supportive.
• Therefore, prevention of the spread of Ebola is
particularly important.

5. EBOLA OUTBREAKS
PRIOR TO 2014

7. OVERVIEW OF CURRENT
OUTBREAKS

8. • Largest and most complex Ebola outbreak.
• More cases and deaths in this outbreak than all others
combined.
• Spread between countries
• Bushmeat is believed to be the origin of the current
Ebola outbreak

9. • The origin has been traced to a two-year-old child from
the village of Gueckedou, south-eastern Guinea
• The child, dubbed Child Zero, died on 6 December
2013.
• Spread to a number of health care workers and then
among their family members
 January to March 2014
 First cases notified in a WHO communiqué on 23 March
2014

10. • On Aug 8, the WHO Director-General declared this
outbreak a Public Health Emergency of International
Concern (PHEIC)
• WHO estimates that some 10,141 people have
contracted the disease so far.
• Heath officials put the death toll at around 4,922
meaning that one in two people who get Ebola in this
outbreak die

11. • But the true toll maybe three times as much: by a
factor of 1.5 in Guinea, 2 in Sierra Leone and 2.5 in
Liberia, and death rate to be 70% of all cases

12. • According to the WHO the fatality rate of Ebola-
infected healthcare workers is 57 per cent.
• This compares with an overall case fatality rate of the
2014 West Africa Ebola outbreak of 49 per cent.
• Around the globe, about 450 health care staffs have
contracted Ebola, and a total of 244 have died.

13.  Country reports fall into two categories:
• those with widespread and intense transmission
(Guinea, Liberia, and Sierra Leone)
• those with or that have had an initial case or cases, or
with localized transmission
(Mali, Nigeria, Senegal, Spain, and USA)
WHO Ebola Response Roadmap

14. EBOLA OUTBREAK IN DEMOCRATIC
REPUBLIC OF THE CONGO

15. • In August 2014, DRC confirmed an outbreak of
EVD in the Djera area of Equateur Province
• The index case-patient was a pregnant woman
• 7th confirmed EVD outbreak in DRC
• This current outbreak has no association with the
ongoing outbreak in West Africa.

19. • Countries with widespread transmission
Country Total
cases
Total
death
CFR
%
Lab
confirm
cases
Lab
confirm
death
HCWs
LIBERIA 4665 2705 58 965 1241 228(103D)
SIERRA
LEONE
3896 1281 33 3389 1008 127(95D)
GUINEA 1553 926 60 1312 732 80(41D)
TOTAL 10,114 4912 49 5666 2981 435(239D)

20. • Countries that reported a case/ imported
case/s
Country Total
cases
Total
deaths
Prob/
Suspect
Lab
confirm
cases
Lab
confirm
death
HCWs
USA 4 1 * 4 1 3(0D)
SPAIN 1 0 * 1 0 1(0D)
MALI 1 1 * 1 1 0
TOTAL 6 2 * 6 2 4

21. • Outbreaks of EVD in Senegal and Nigeria were
declared over on 17 October and 19 October 2014,
respectively
Country Total cases
(HCWs)
Lab confirmed
cases
Total deaths
NIGERIA
(Lagos)
20(11) 19 8(5)
SENEGAL 1 1 0
TOTAL 21(11) 20 8(5)

22. • DRC will therefore be declared free of EVD 42 days
after the date of the second negative test if no new
cases are reported.
Country Total
cases
Lab
confirm
cases
Prob
case
Sus
case
Total
death
HCWs
DRC 67 38 28 1 49 8(8D)

23. Case Definition for Ebola Virus Disease
(CDC)

24. - Person Under Investigation (PUI)
• A person who has both consistent symptoms and risk
factors as follows:
1. Clinical criteria,
 fever >38.6⁰ Celsius or 101.5⁰ Fahrenheit,
 additional symptoms such as severe headache, muscle
pain, vomiting, diarrhea, abdominal pain, or
unexplained hemorrhage; AND

25. 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 or nonhuman primates from
disease-endemic areas.

26. • Probable Case
A PUI whose epidemiologic risk factors include
high or low risk exposure(s)
• Confirmed Case
 A case with laboratory-confirmed diagnostic evidence
of Ebola virus infection

27. • High risk exposures
A high risk exposure includes any of the following:
 Percutaneous (e.g., needle stick) or mucous membrane
exposure to blood or body fluids of EVD patient
 Direct skin contact with, or exposure to blood or body
fluids of, an EVD patient without appropriate personal
protective equipment (PPE)

28.  Processing blood or body fluids of a confirmed EVD
patient without appropriate PPE or standard biosafety
precautions
 Direct contact with a dead body without appropriate
PPE in a country where an EVD outbreak is occurring

29. • Low risk exposures
A low risk exposure includes any of the following
 Household contact with an EVD patient
 Other close contact with EVD patients in health care
facilities or community settings.

30. • Close contact is defined as
a. being within approximately 3 feet (1 meter) of an
EVD patient or within the patient’s room or care area for
a prolonged period of time (e.g., health care personnel,
household members) while not wearing recommended
personal protective equipment (PPE)
.

31.  b. having direct brief contact (e.g., shaking hands) with
an EVD patient while not wearing recommended
personal protective equipment
• Brief interactions, such as walking by a person or
moving through a hospital, do not constitute close
contact

32. • No known exposure
 Having been in a country in which an EVD outbreak
occurred within the past 21 days and having had no
high or low risk exposures

33. Ebola case-classification criteria
(WHO)
• SUSPECT:
 Any person, alive or dead, who has (or had)
sudden onset of high fever and had contact with a
suspected, probable or confirmed Ebola case, or a
dead or sick animal
OR

34.  any person with sudden onset of high fever and at least
three of the following symptoms: headache, vomiting,
anorexia/ loss of appetite, diarrhoea, lethargy, stomach
pain, aching muscles or joints, difficulty swallowing,
breathing difficulties, or hiccup;
OR
 any person with unexplained bleeding
OR
 any sudden, unexplained death.

35. • PROBABLE:
 Any suspected case evaluated by a clinician
OR
 any person who died from ‘suspected Ebola and had an
epidemiological link to a confirmed case’ but was not
tested and did not have laboratory confirmation of the
disease.

36. • CONFIRMED :
 A probable or suspected case is classified as
confirmed when a sample from that person tests
positive for Ebola virus in the laboratory.

37. Passenger categories
(MOFWH)

38. Category I: low risk, asymptomatic, arrived or transited
from the endemic countries in the past 21 days.
Report in case the symptoms develop.
Category II: medium risk, asymptomatic, arrived or
transited from the endemic countries, history of contact
with the known case of EVD or were involved in taking
care of the suspect or known case in the last 21 days.

39. Category III: high risk, showing symptoms of EVD and
are arriving from endemic countries with history of
contact with known or suspect case or were involved in
taking care of such case in the last 21 days

40. EPIDEMIOLOGY

41. CLASSIFICATION
Order :Mononegavirales
•Enveloped, nonsegmented, negative
strand RNA viruses
• Long rods (800-1000 nm)
•Replication = 8 hours
Family :Filoviridae contains 3 genera:
•Ebolavirus (1976)
•Marburgvirus –(1967)
•Cuevavirus –(2002)

42. Ebolavirus species
 Zaire ebolavirus: 1976, Democratic Republic of Congo.
 Sudan ebolavirus: 1976, Sudan.
 Bundibugyo ebolavirus: 2007, Uganda.
 Taї Forest ebolavirus (formerly Côte d’Ivoire
ebolavirus): 1994, Ivory Coast.
- Single case, veterinary worker handling primate.
 Reston ebolavirus: 1989, Philippines.
- Macaques, swine.
- Human lab workers seropositive but no clinical disease.

43. NATURAL
RESERVIOR
• Suspected – Zoonotic
• Fruit bats are considered
the most likely natural reservoir of the Ebola virus;
• Bats were known to reside in the cotton factory in which
the first cases for the 1976 and 1979 outbreaks were
employed, and they have also been implicated
in Marburg virus infections in 1975 and 1980.

44. TRANSMISSION
• EVD is believed to occur after an ebola virus is
transmitted to an initial human by contact with an
infected animal's body fluids.
• Airborne transmission has not been documented during
previous EVD outbreaks

45. FRUIT BATS (?)
NON HUMAN
PRIMATES
SUSCEPTIBLE INDIVIDUALS
OTHER INDIVIDUALS
Direct contact (broken skin or
mucous membrane) with blood /
body fluids/contaminated medical
equipments like needles syringes
& surfaces & materials ( bedding
, clothings) contaminated with
infected fluids
Blood, secretion , organs & other
bodily fluids
Consumption of Bushmeat(?)
Partially eaten fruits

46. BUSHMEAT

47. • During an outbreak - health care workers and close
contacts of those with the infection
• Burial ceremonies can also play a role
• People remain infectious as long as their blood and
body fluids, including semen and breast milk, contain
the virus after recovery from illness
• Transmission through the semen can occur upto 7
weeks after recovery from illness.

48. PATHOGENESIS
VIRUS
CAPILLARY
VESSELS
LEAKAGE OF
BLOOD & SERUM
INVADES IMMUNE
SYSTEM + TRANSPORT
THE VIRUS
PROFUSE & OFTEN FATAL
INTERNAL BLEEDING
INTERFERES WITH
SIGNALING OF WBC

49. SIGNS AND SYMPTOMS
• The incubation period ranges from 2 to 21 days
(most commonly 8-10 days)
• Nonspecific presentation
• Most common symptoms - fever (87%), fatigue (76%)
vomiting (68%), diarrhea (66%), loss of appetite (65%).
• GIT symptoms-
• Respiratory symptoms-
• Skin-

50. • Bleeding does not affect every patient with Ebola and
usually presents as small subcutaneous bleeding vs
frank hemorrhage.
• More severe symptoms at presentation - predict a
higher risk for mortality.

51. • Symptoms become increasingly severe –
 mental confusion, coma
 bleeding (internal & subcutaneous)
 shock, and
 multi-organ failure.
• Most patients with fatal disease die between days 6 and
16 of complications.

52. SIGNS & SYMPTOMS

53. • Early symptoms of EVD may be similar to those
of malaria, dengue fever, typhoid, dysentery,
influenza or other tropical fevers, before the disease
progresses to the bleeding phase.
• Laboratory findings: Low WBC count,
Low Platelets count,
Elevated liver enzymes
• People are infectious as long as their blood and
secretions contain the virus

54. DIAGNOSIS
• Difficult to distinguish EVD from other infectious
diseases
• Medical history, especially travel and work history
along with exposure
• The diagnosis is confirmed by isolating the virus,
detecting its RNA or proteins, or
detecting antibodies against the virus in a person's
blood

55. Timeline of infection Diagnostic tests available
Within a few days after symptoms begin • Antigen-capture enzyme-linked
immunosorbent assay (ELISA) testing
• IgM ELISA
• Polymerase chain reaction (PCR)
• Virus isolation
Later in disease course or after recovery • IgM & IgG antibodies
Retrospectively in deceased patients • Immunohistochemistry testing
• PCR
• Virus isolation

56. • Filovirions can be seen and identified in cell culture
by electron microscopy due to their unique filamentous
shapes
• Samples from patients are an extreme biohazard risk;
laboratory testing on non-inactivated samples should be
conducted under maximum biological containment
conditions

61. TREATMENT
Approach considerations:
• Currently, no specific therapy is available that has
demonstrated efficacy
• General medical support is critical, which should be
administered with strict attention to barrier isolation
• Surgical intervention generally follows a mistaken
diagnosis, which may be fatal for the patient and for any
surgical team members who become contaminated with
the patient’s blood

62. • Survivors can produce infectious virions for prolonged
periods. Therefore, strict barrier isolation in a private
room away from traffic patterns must be maintained
throughout the illness
• Steroid therapy has no role
• No role for antibiotics unless there is evidence of
secondary bacterial infection

63. Supportive care:
• Supportive therapy - rehydration with oral or intravenous
fluids is one of the most important supportive measures
• For high grade fever - Tepid sponging and tablet
paracetamol. No other analgesic, particularly tablet
aspirin should not be given
• Bone marrow suppression - platelets transfusion when
the count is below 20000/cu.mm or bleeding from any
sites irrespective of platelet count

64. • In case of severe shock and vomiting patient may be
treated with intravenous fluid with crystalloid or colloid
• Blood transfusion - In severe gastrointestinal bleeding
and shock (replacement of coagulation factors and
heparin if DIC develops)
• Dialysis in case of renal failure
• Co-infection with EVD should be immediately treated
with proper antibiotic

65. Pharmacologic therapy:
• Nucleoside analogue inhibitors of the cell encoded enzyme
SAH have been shown to inhibit Zaire Ebola virus replication
in adult BALB/c mice infected with mouse-adapted Ebola
virus
• Interferon beta early after exposure led to a significant
increase in survival time, in rhesus macaques infected with a
lethal dose of Ebola virus
• Passive immunity- Equine-derived hyperimmune globulins
and human-derived convalescent immune globulin
preparations

66. • Ebolavirus -infected cynomolgus macaques, use of human
recombinant interferon alfa-2b in conjunction with
hyperimmune equine immunoglobulin G (IgG) delayed
but did not prevent death
• A recombinant human monoclonal antibody directed
against the envelope glycoprotein (GP) of Ebola virus has
been demonstrated to possess neutralizing activity
• DNA vaccines expressing either envelope GP or
nucleocapsid protein (NP) genes of Ebola virus have been
demonstrated to induce protection in adult mice exposed
to the virus

67. ZMAPP
• Under development for treatment of EVD
• First used experimentally to treat some people with EVD
in the present outbreak, but as of August 2014 it had not
yet been tested in a clinical trial to support widespread
usage in humans
• Like intravenous immunoglobulin therapy, ZMapp
contains neutralizing antibodies that provide passive
immunity to the virus by directly and specifically
reacting with it in a "lock and key" fashion

68. • Composed of three monoclonal antibodies (mAbs),
chimeric monoclonal antibody c13C6 from a previously
existing antibody cocktail called "MB-003" and two
chimeric mAbs from a different antibody cocktail called
ZMab, c2G4 and c4G7
• ZMapp is manufactured in the tobacco plant Nicotiana
benthamiana in the bioproduction process known as
"pharming"

69. Vaccines:
• Currently no vaccine is available
• Two candidate vaccines in phase 1 clinical trial:
 One (cAd3-ZEBOV) has been developed by GlaxoSmithKline
in collaboration with the US National Institute of Allergy and
Infectious Diseases which uses a chimpanzee-derived
adenovirus vector with an Ebola virus gene inserted
 The second (rVSV-ZEBOV) was developed by the Public
Health Agency of Canada in Winnipeg which uses an
attenuated or weakened vesicular stomatitis virus, a pathogen
found in livestock; one of its genes has been replaced by an
Ebola virus gene

70. CONTROLAND PREVENTION
• Good outbreak control relies on applying a package of
interventions, namely case management, surveillance
and contact tracing, a good laboratory service, safe
burials and social mobilisation
• Community engagement is key to successfully
controlling outbreaks
• Raising awareness of risk factors for Ebola infection and
protective measures that individuals can take is an
effective way to reduce human transmission

71. Risk reduction messaging should focus on:
• Reducing the risk of wildlife-to-human transmission
• Reducing the risk of human-to-human transmission
• Outbreak containment measures

72. Reducing the risk of wildlife-to-human transmission
• From contact with infected fruit bats or monkeys/apes
and the consumption of their raw meat
• Animals should be handled with gloves and other
appropriate protective clothing
• Animal products (blood and meat) should be thoroughly
cooked before consumption

73. Reducing the risk of human-to-human transmission
• From direct or close contact with people with Ebola
symptoms, particularly with their bodily fluids
• Gloves and appropriate personal protective equipment
should be worn when taking care of ill patients at home
• Regular hand washing is required after visiting patients
in hospital, as well as after taking care of patients at
home

74. Interim guidelines for hospital infection control
while managing the suspect/ case of Ebola Virus Disease
(EBVD)
Component Recommendation Comments
Patient Placement Single patient
room (containing a
private bathroom)
with the door
closed
To maintain a log
of all persons
entering the
patient's room
To ensure
appropriate and
consistent use of
PPE by all
persons entering the
patient room

75. Component Recommendation Comments
Personal Protective
Equipment (PPE)
All persons entering the patient room should
wear at least:
• Gloves
• Gown (fluid resistant or impermeable)
• Eye protection (goggles)
• Facemask to prevent
• splashes on nose and
• mouth
• Face shield, if used, will
• protect eye, nose and
• mouth
• Closed shoes
 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
To ensure appropriate
and
consistent use of PPE
by all
persons entering the
patient room

76. Component Recommendation Comments
Patient Care
Equipment
• Dedicated medical equipment (preferably
disposable, when possible) should be used
for the provision of patient care
• All non-dedicated, non-disposable medical
equipment used for patient care should be
cleaned and disinfected according to
manufacturer's instructions
The Equipment should
be as far as possible
dedicated to isolation
rooms
Patient Care
Considerations
• Limit the use of needles and other sharp
objects as much as possible
• Limit the use of phlebotomy and laboratory
testing to the minimum necessary for
essential diagnostic evaluation and patient
care
• If the use of sharp objects cannot be
avoided, ensure to follow safe injection
practices.
All needles and sharps
should be handled with
extreme care and
disposed in puncture-
proof, sealed containers
& follow as per hospitals
guidelines for disposal

77. Component Recommendation Comments
Aerosol Generating
Procedures on
patients
To be avoided as far as possible
If unavoidable follow a procedure to
minimize exposures from aerosol-generating
procedures when performed on Ebola HF
patients
Visitors /relatives should not be present
Limit the number of health care providers
present during the procedure for the activity
Conduct the procedures in a isolation room
as far as possible
HCP should wear complete PPE with N95
masks during the procedure
Disinfect the room after the procedure
If re-usable equipment is used, they should
be cleaned and disinfected
Collection and handling of soiled re-usable
respirators must be done by trained individuals
using PPE
Because of the potential
risk to individuals
reprocessing reusable
respirators, disposable
filtering face piece
respirators &
equipment's should be
preferred.
Define a list of
procedures like
intubation, etc.

78. Component Recommendation Comments
Hand Hygiene • To perform hand hygiene frequently,
including before and after all patient
contact, contact with potentially infectious
material, and before putting on and upon
removal of PPE, including gloves.
• Ensure that supplies for performing hand
hygiene like hand rub or soap & water are
freely available.
Hand hygiene in
healthcare settings can
be performed by
washing with soap and
water or using alcohol-
based hand rubs. If
hands are visibly soiled,
use soap and water, not
alcohol-
based hand rubs.
Environmental
Infection Control
• Environmental cleaning and disinfection and
safe handling of potentially contaminated
materials is paramount
• Health care providers performing
environmental cleaning and disinfection
should carry out all activities after wearing
complete set of PPE & follow hospital
infection control guidelines strictly
Ebola virus is
susceptible to all
commonly used
disinfectants eg. sodium
hypochlorite (1%)

79. Component Recommendation Comments
Safe injection
practices
• Any injection equipment or parenteral
medication container that enters the patient
treatment area should be dedicated to that
patient and disposed of at the point of use
disposable syringes & needles are only to be
used
Follow safe injection
practices
Duration of
Infection Control
Precautions
• Till the patient is in hospital & as the patient
is infectious even after he /she is
asymptomatic hence even at home safety
precautions to be followed till two months
from the date of onset of the symptoms
appeared
It will help in
containment
Self health
monitoring
• Recommended for all health care providers
and visitors & contacts. For a period of 21
days of last exposure.
Supports spread of
disease & containment
there off

80. Outbreak containment measures
Contact tracing:
• Any person who has had close contact with a patient under
investigation/treatment for suspected, probable or confirmed
case of Ebola Virus Disease infection (should be carefully
monitored for the appearance of symptoms of Ebola Virus
Disease
• Close contact:
– Anyone who provided care for the patient, including a health care
worker or family member, or who had other similarly close physical
contact;
– Anyone who stayed at the same place (e.g. lived with, visited) as a
probable or confirmed case while the case was ill.

82. Guidelines for healthcare providers:
Health workers while taking care of these patients should
observe the following, in addition to universal precautions to
avoid exposure to infected blood, fluids, or contaminated
environments or objects :
 Should use personal protection equipment
 Should not reuse protective equipment or clothing unless they
have been properly disinfected with 1% bleach or phenolic
products
 Should change gloves between caring for each patient
suspected of having Ebola

83.  Invasive procedures should be carried out under strict,
safe conditions
 For aerosol generating procedures PPE should include
respiratory protection N95 and in airborne isolation room
 Infected patients should be kept separate from other
healthy patients
 Dedicated medical equipment should be used
 All non-dedicated, non-disposable medical equipment
used for patient care should be cleaned and disinfected as
per manufacturer’s instructions and hospital policies

84.  Use of injections and sharps should be limited
 If the use of sharp objects cannot be avoided, ensure that
the precautions are observed

85. Advisory for Airlines on Ebola Virus Disease (EVD):
1. In flight announcement as below:
“In view of the current threat of Ebola Virus Disease
(EVD): which has high mortality and is currently reported in
West African Countries, travelers who have any fever, weakness,
muscle pain, headache, sore throat, vomiting, diarrhea, rash,
bleeding should report immediately to the airlines crew and at the
immigration/medical unit on arrival. This is important for early
diagnosis for prompt management and preventing spread. In case
any of these symptoms develop within 30 days of arrival in the
country the traveler should seek medical assistance from the
designated hospitals and also inform the airport health office.”

86. 2. All airlines should keep
a. First aid kits, universal precaution kits as per the ICAO
guidelines and
b. A stock of triple layer masks (25 Nos.), disposable hand
gloves (around 25) hand sanitizer and disposal bags: these
are to be used for any passenger reporting with symptoms
of Ebola Virus Disease (EVD) and co-passengers who are
likely to have contacted the disease.

87. 3. Assist the staff of Health unit at the airport during
disembarkation for contact tracing of travelers identified as
suspect by providing Public Health Passenger Locator cards
(as requested by the Airport Health officer).
4. Follow aircraft disinfection procedures (as
recommended by WHO/ICAO).

88. Advisory for specific public health measures for travelers
suspected of EVD
• Distancing of other passengers , if possible from the
symptomatic passenger(reseating)
• Covering nose and mouth of the patient with a surgical
facemask (if tolerated)
• Limiting contacts to the passenger to the minimum necessary
• Only one or two (if ill passenger requires more assistance)
cabin crew should be taking care of the ill passenger and they
should be using the Universal Precaution Kit

89. • Hand washing with soap after any direct or indirect
contact with the passenger
• Immediate notification of authorities at the destination
airport in accordance with procedures promoted by the
International Civil Aviation Organization (ICAO)
• Immediate isolation of passenger upon arrival

90. • The possibility of transmission to other co-passengers
and crew on board the aircraft should be assessed by
health care providers on arrival
• Based upon proximity to the index patient, contact
tracing should be considered:
 Passengers and crew with reported direct contact
 Passengers seated in an adjacent seat to the index patient
 Cleaning staff of affected aircraft section

93. Conclusion
• Prevention of world wide outbreak lies within the
education of what the virus is capable of doing, how
Ebola virus can be properly treated and by performing
prompt action to isolate the virus before it has dispersed
• Because of the nature and extent of international travel
today, it is possible that importations of diseases like
Marburg, Lassa and Ebola will take place
• Comprehensive national programs for the diagnosis,
management and surveillance of such patients and their
personal contacts should be developed

94. • Control of person to person transmission remains as a
greatest challenge in control and prevention of the
infection
• Our approach to the future management of these
problems must remain dynamic and adaptable to new
developments in the epidemiology, control and
prevention of these diseases

96. REFERENCES
• The Ebola Response Roadmap is available at:
http://www.who.int/csr/resources/publications/ebola/res
ponse-roadmap/en/. Accessed October 28, 2014
• WHO | Ebola virus disease. Available at:
http://www.who.int/mediacentre/factsheets/fs103/en/
1/7. Accessed October 22, 2014

97. • National Institute for Communicable Diseases | Alerts | Ebola Virus
Disaease Outbreak: Situation Update, 27 October 2014. Available at:
http://www.nicd.ac.za/?page=alerts&id=5&rid=430.
Accessed October 28, 2014.
• Ebola: What Clinicians Need to Know. Available at:
http://www.medscape.org/viewarticle/832353?src=wnl_cme_revw.
Assessed October 28, 2014.
• Case Definition for Ebola Virus Disease (EVD):Centers for Disease
Control and Prevention . Available at :
http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-
map.html#areas. Accessed October 22, 2014
• Advisories on (EVD) Ebola Virus Disease. Ministry of health and
family welfare. Available at
http://mohfw.nic.in/index1.php?lang=1&level=2&sublinkid=4362&lid
=2884. Last accessed on October 28, 2014.