EBOLA VIRUS DISEASE TO UNIVERSITY COMMUNITY OF IGNATUIS AJURU UNIVERSITY OF EDUCATION

1. PUBLIC ENLIGHTENMENT
ON
EBOLA VIRUS DISEASE

3. EBOLA SCARE

4. OUTLINE
 Introduction
 History
 Current outbreak
 Causative agent
 Transmission
 Clinical presentation of EVD
 Diagnosis
 Management
 Efforts of Government in containing the disease
 Common myths on Ebola

5. INTRODUCTION
 Ebola virus disease (EVD) was formerly known as Ebola
haemorrhagic fever. It is a severe and often fatal illness in
humans.
 About 90% of people that are infected with Ebola virus will die
from it. It is one of the deadliest diseases in the world killing in
few weeks.
 Ebola virus is classified as a biosafety level 4 agent, as well as
a Category A bioterrorism agent by the Centers for Disease
Control and Prevention.
 EVD is a zoonotic infection meaning that it a disease of animals
which is transmissible to man under natural conditions.
 There have been several recorded outbreaks of EVD in some
African countries prior to the current epidemic in West Africa.

6. HISTORY
 The first outbreak of EVD was in 1976 in Yambuku, Zaire (now
Democratic Republic of Congo).
 The outbreak recorded 318 cases and 280 deaths giving a case
fatality rate of about 88%.
 Most of the deaths were among patients who were given
injections with contaminated needles.
 At about the same time in 1976, another outbreak occurred in
Maridi, Sudan (present day South Sudan) that recorded 284
cases and 151 deaths with fatality rate of over 53%.

7. HISTORY CONTD
 The name Ebola originated from Ebola River around which
Yambuku, where the first outbreak that occurred was located.
 Ngoy Mushola -a Congolese medical doctor was the first
person to record a description of the Ebola virus in 1976.
 The first patient to be diagnosed of EVD was Mayinga
N’Seka: a nurse in Zaire in 1976.
 Since after the 1976 outbreaks in Zaire and Sudan, there have
been several epidemics of the disease in other parts of Africa.

8. CHRONOLOGY OF PREVIOUS EBOLA VIRUS
DISEASE OUTBREAKS
Year Country of
occurrence
EV species Recorded
cases
Deaths
1976 DRC Zaire 318 280
1976 Sudan Sudan 284 151
1977 DRC Zaire 1 1
1979 Sudan Sudan 34 22
1989 USA Reston 4 0
1994 Gabon Zaire 52 31
1994 Cote de’ Ivoire Tai Forest 1 0
1995 DRC Zaire 315 254
1996(Jan-April) Gabon Zaire 31 21
1996(Jul-Dec) Gabon Zaire 60 45
1996 South Africa Zaire 1 1
2000 Uganda Sudan 425 224
2001-2002 Gabon Zaire 65 53

9. CHRONOLOGY OF PREVIOUS EBOLA VIRUS
DISEASE OUTBREAKS CONTD
Year Country of
occurrence
EV species Recorded
cases
Deaths
2001-2002 Congo Zaire 59 44
2003(Jan-April) Congo Zaire 143 128
2003(Nov-Dec) Congo Zaire 35 29
2004 Sudan Sudan 17 7
2005 Congo Zaire 12 10
2007 DR Congo Zaire 264 187
2007 Uganda Bundibugyo 149 37
2008 DR Congo Zaire 32 14
2011 Uganda Sudan 1 1
2012 Uganda Sudan 24 17
2012 Uganda Sudan 7 4
2012 DR Congo Bundibugyo 57 2

10. CURRENT OUTBREAK
 Current epidemic ravaging West African countries is the largest and
most severe Ebola outbreak to occur since the virus was first
identified in 1976, in terms of cases and deaths.
 It began in Guinea in March 2014 and has since spread to Liberia,
Sierra Leone, Nigeria and now DRC.
 On 8 August 2014, the World Health Organization (WHO) declared
the outbreak a Public Health Emergency of International Concern.
 Public Health Emergency of International Concern is a
designation that invokes obligatory legal measures on disease
prevention, surveillance, control and response by 194 signatory
countries of WHO.
 As at 20th August, 2014, a total of 2615 suspected cases with 1427
deaths have been reported by WHO, of which 1528 cases and 844
deaths have been confirmed to be EVD.

11. WEST AFRICA

12. WEST AFRICAN COUNTRIES RAVAGED BY EVD

13. CUMULATIVE TOTALS OF CASES AND DEATHS OVER TIME

14. CURRENT OUTBREAK CONTD
 The first case in Nigeria was reported by the WHO on 25th July, 2014:
Patrick Sawyer- a Liberian Ministry of Finance official, that flew from Liberia
to Nigeria after exposure to the virus and died in a Lagos hospital soon after
arrival. This is the first case of Ebola disease to be internationally exported
through air travel.
 So far, Nigeria has recorded 14 confirmed cases (12 primary and 2
secondary contacts) including 5 deaths, five fully recovered and four others
still in treatment centre.
 The deaths were the index case, the most senior doctor(female consultant
physician) who participated in the management of the index case, 2 health
workers and an ECOWAS protocol staff that welcomed Patrick Sawyer at
the airport.
 About 213 primary and secondary contacts are currently under surveillance.
6 out of the 213 are under watch in Enugu where a nurse who had treated
Sawyer travelled before falling sick.
 Mainland Hospital, Yaba - an infectious diseases hospital owned by the
Lagos State Government is being used for isolation and treatment of
confirmed cases.

15. Patrick Sawyer

16. DR STELLA ADEDEVOH
Dr Stella Adedevoh

17. CAUSATIVE AGENT
 EVD is caused by Ebola virus.
 It is an RNA virus of the Filoviridae family: the family of filamentous
viruses.
 There are 5 species of Ebola virus named after their original site of
outbreak:
1. Zaire Ebola virus
2. Sudan Ebola virus
3. Bundibugyo Ebola virus
4. Tai Forest Ebola virus
5. Reston Ebola virus
 Zaire Ebola virus is the most virulent strain and it is implicated in
the current epidemic.

19. Ebola virus

20. TRANSMISSION
Transmission: This is by direct contact from:
1. Animal to human.
2. Human to human.
Animal to human: Transmission from animals to humans is probably from:
 Fruit bats
 Primates: monkeys, apes, gorillas, etc.
 Forest antelopes
 Porcupines
 Pigs

21. TRANSMISSION

22. TRANSMISSION
Transmission

23. BATS
Bats

24. Non-human primate

25. FOREST ANTELOPE
Forest Antelope

26. PORCUPINE
Porcupine

27. TRANSMISSION CONTD
2. Human to human: Transmission is by direct contact with body
fluids of infected cases or corpses of those that have died of the
disease.
o The virus can be found in any of the following body fluids:
o Sweat
o Blood
o Saliva
o Break milk
o Urine
o Semen
o Tears
 People are not contagious until they develop symptoms.
 Family members and health workers are most affected.
 Spread through air has not been confirmed.

28. CLINICAL PRESENTATION OF EVD
Incubation period: 2-21 days.
Clinical symptoms: These are divided into early and late symptoms.
Early symptoms: Non-specific and usually appear between 2-
10 days after exposure. They include:
 High grade fever
 Headache
 Joint and muscle pains
 Tiredness
 Nausea
 Rashes
 Sore throat
 Cough
 Chest pains

29. Typical papular rash

30. CLINICAL PRESENTATION OF EVD CONTD
Late Symptoms: May appear from 11-21 days of exposure.
 Bleeding from the eyes, nose, ears, mouth, anus, etc.
 Vomiting that may contain blood.
 Diarrhoea which may last for 10 days that may contain blood.
 Cough with bloody sputum.
 Swelling and redness of the eyes.
 Bleeding into the skin.
 Enlargement of the liver.
 Testicular Swelling with pain.

31. Bleeding into the skin

32. Bleeding into the skin

33. EFFECT OF EBOLA VIRUS ON THE BODY
The sequence of events on the body are:
 Contact with infected body fluids that contain the virus.
 Replication of the virus in the tissues of the infected person.
 Circulation of the virus in the blood in large numbers.
 Dissemination of the virus into major organs and tissues.
 Reduction in number of all blood cells including platelets that are
responsible for blood clotting.
 Severe bleeding from all possible external openings including skin
and internal organs and tissues.
 Increased blood vessel permeability causing blood to ooze out of
the vessels into surrounding tissues and organs.
 Decreased circulating blood volume causing shock.
 Clotting disorder.
 Swelling of internal organs and tissues including the brain.
 Death from shock, clotting disorder, and brain swelling.

34. DIAGNOSIS
Is made by:
 High index of suspicion.
 History of sudden onset of severe febrile illness not
responding to treatment for common ailments.
 History of recent travel to countries ravaged by the epidemic.
 History of contact with wild life
 Recent contact with an infected person: living or dead.

35. LABORATORY DIAGNOSIS
General lab findings include:
 Low white blood cell and platelet count.
 Low red blood cell count.
 Deranged electrolytes.
 Proteinuria.
 Elevated liver enzymes.
 Low clotting profile.

36. CONFIRMATORY TEST
Confirmatory test can be done in an appropriately equipped
laboratory using a multitude of approaches including:
 ELISA based techniques to detect anti-Ebola antibodies or
viral antigens.
 RT-PCR to detect viral RNA.
 Immunoelectron microscopy to detect Ebola virus particles
in tissues and cells.
 Indirect immunofluorescence to detect antiviral antibodies.

37. ACCREDITED LABORATORIES FOR EVS IN NIGERIA
Four laboratories that specialize in testing of the Ebola virus were
named by the Federal Government. These are:
 Centre for Disease Control in Asokoro, Abuja.
 Lagos University Teaching Hospital.
 University College Hospital, Ibadan.
 Redeemers University Laboratory, Lagos.
 Irrua Specialist Teaching Hospital Edo State
 More laboratories and mobile test centers are planned to be sited
in Jos, Kano and Enugu. At least 9 laboratories are to be sited
across the country before the end September, 2014.

38. LABORATORY SCIENTIST IN BSL4 LABORATORY

39. OTHER DISEASES WITH SIMILAR FEATURES
 Malaria
 Typhoid
 Cholera
 Dysentery
 Lassa fever
 Marburg
 Dengue fever

40. MANAGEMENT
There are currently no vaccines or drugs of proven efficacy for EVD. The management
goals are therefore to:
1. Prevent further spread to uninfected persons.
2. Treatment of infected persons through supportive care and use of experimental
drugs where available and approved.
Prevention in the health care settings:
In health facilities and clinical settings, this is achieved by:
a. Isolation and barrier-nursing of all infected cases.
b. Quarantine of all contacts of infected persons.
c. Strict observance of universal precautions by health workers in clinical settings.
d. Wearing of standard containment gears by health workers attending to infected
persons and corpses.
e. Decontamination and disinfection of all materials that have had contact with
infected cases and their secretions.

41. ISOLATION CENTRE

42. HEALTH WORKERS KITTED FOR WORK

44. MANAGEMENT CONTD
Prevention in the community:
 Avoid contact with infected individuals.
 Minimize stay in crowded places like churches, mosques, political rallies,
crusades, markets, etc.
 Regular hand washing with soap, and use of hand sanitizers where
possible.
 Cover mouth with handkerchief when sneezing or coughing.
 Hygienic disposal of all human and animal wastes.
 Infected corpses should be cremated or disposed aseptically in
designated place.

45. MANAGEMENT CONTD
Prevention in the community:
 Seek medical care for all cases of febrile illness.
 Regular clearing and disinfection of animal farms.
 Cull infected animals.
 Animal products should be thoroughly cooked before consumption.
 Avoid eating bats and bush meat particularly monkeys, apes etc.
 Avoid eating fruits that has been bitten by bats.
 Report every suspected case to a health facility or through Ebola toll free
numbers: 08023169485,08033086660,0800EBOLAHELP

46. Wash your hands Regularly

47. WASH YOUR HANDS REGULARLY
Wash your hands Regularly

48. QUEEN ELIZABETH TRADITIONALLY WEARS
HAND GLOVES FOR OCCASION

49. HEALTH WORKERS EVACUATING CORPSE
FROM HOSPITAL.

50. CORPSE BEING TAKEN FOR BURIAL

51. SMOKED ROAD SIDE BUSH MEAT

52. ALTERNATIVES TO BUSH MEAT

53. MANAGEMENT CONTD
Treatment of infected persons: There is currently no proven effective
antiviral drug in the market. The aim of treatment is to preserve the
patient’s life through supportive care.
Treatment is therefore directed at:
Relief of symptoms.
Maintaining renal function.
Maintenance of electrolyte and fluid balance.
 Combating haemorrhage and shock.

54. EXPERIMENTAL DRUGS
The WHO has approved the use of experimental drugs for the
treatment of this deadly virus.
 Zmapp: A drug yet to undergo human clinical trial before the
onset of the current epidemic but is being used for the 2 infected
Americans.
 TKM Ebola- an experimental drug approved for use by FDA
 Nanosilver: An experimental drug developed by a Nigerian in
diaspora for the treatment of Ebola.
 Nanosilver however, failed to meet the requirements of the
National Health Research Ethics Code for use in Nigeria.

55. AMERICAN SURVIVORS OF EVD

56. EXPERIMENTAL DRUGS CONTD
 Garcinia kola (bitter kola): Preliminary study of the plant
in the 1990s showed signs that it may benefit Ebola victims
by slowing down multiplication of the virus.
 Yet to undergo animal and human trials thus not
scientifically proven as remedy for EVD.

57. Garcinia kola(bitter kola)

58. HOPE FOR VACCINES
 The WHO has said that clinical trials of a vaccine for the
Ebola virus may begin in September 2014 and be made
available by 2015.
 WHO’s head of vaccines and immunization, Jean-Marie
Okwo Bele stated that September 2014 is being targeted
for the start of clinical trials, first in the United States and
later in African countries where we currently have the
cases.

59. PROTECTIVE GEAR

60. CATHOLIC BISHOP’S CONFERENCE OF NIGERIA SUSPENDS EXCHANGE OF SIGN OF PEACE
AND RECEPTION OF HOLY COMMUNION WITH THE TONGUE

61. GOVERNMENT’S EFFORTS IN CONTAINING THE EPIDEMIC
 Declared EVD national health emergency with all ports of
entry into the country on Red Alert.
 Set up committee on EVD.
 Earmarked 1.9billion naira for EV related activities.
 Included EV screening certificates as precondition for
travelling in and out of the country.
 Banned interstate transfer of corpse without dead certificate.
 Set up official Ebola information website on
Ebola(www.ebolaalert.org) and toll free number:
0800EBOLAHELP.
 On 31st July, 2014 the WHO and West Africa nations
announced $100 million in aid to help contain the disease
across West Africa.

62. ONYEBUCHI CHUKWU-MINISTER OF
HEALTHOnyebuchi Chukwu-
Minister of Health

63. MARGARET CHAN- WORLD HEALTH
ORGANIZATION DIRECTOR GENERALMargaret Chan-World
Health Organization
Director General

64. COMMON MYTHS ABOUT EBOLA
 Ebola virus was sent by Boko Haram.
 EV was sent by the West to depopulate Africa.
 EV is a sign of end time or punishment from God or was sent by
enemies
 EV does not exist.
 EVD can be prevented by drinking salt water and bathing with same.
 I cannot get EVD because it is not my portion; then whose portion?
 EVD can be cured by laying of hands and attending night vigils.
 Sleeping with virgins can cure EVD.

65. SALT SOLUTION
Salt Solution

66. KIDNAP VICTIM’S PLIGHT

67. RECAP
 Ebola is a very scary viral disease that kill most of its victims with no
proven cure or vaccine yet.
 It is contracted through direct contact with body fluids of infected persons
including corpses.
 Symptoms include fever, headache, diarrhea, vomiting, weakness, joints
and muscle pains, chest pain, cough, skin rashes, bleeding from all
openings in the body.
 Protect yourself by washing your hands with soap and water, disinfect and
fumigate your surroundings
 Use protective gear if you must care for a sick person.
 Report suspicious symptoms in yourself or anyone else to hospital.
 Avoid bush meat for now and educate every one.

68. FINALLY
 Ebola disease is an extraordinary outbreak that
requires extraordinary measures.
 Together (armed with the right information) we can
defeat it.
 All hands must be on deck!

69. MERCI BEAUCOUP