Ebola virus disease is a severe, often fatal illness caused by the Ebola virus. The virus was first discovered in 1976 near the Ebola River in the Democratic Republic of Congo. The 2014 outbreak in West Africa was the largest in history, infecting thousands and killing over 11,000. The virus is transmitted through direct contact with body fluids of infected humans or animals. Common symptoms include fever, headache, muscle pain and weakness. While there is no approved vaccine, treatment involves supportive care to improve symptoms.

1. EBOLA VIRUS DISEASE
Rifat Mannan,MD
Resident, Dept. of Pathology
Mt.Sinai St.-Luke’s Roosevelt Hospital Center,
New York

2. What is Ebola?
• EBOLA VIRUS DISEASE [previously called Ebola
Hemorrhagic Fever]is a fatal viral hemorrhagic
fever , caused by Ebola virus.

3. • The first Ebolavirus species was discovered in
1976 in the Democratic Republic of the Congo
near the Ebola River.
• Since then, outbreaks have appeared
sporadically.

5. 2014 EVD OUTBREAK

6. 2014 EVD OUTBREAK

7. US patients
• On 31 July 2014, CDC issued a travel advisory for
Guinea, Liberia and Sierra Leone, warning against non-essential
travel.
• American aid worker Kent Brantly, infected with the
Ebola virus, was flown to the US at the beginning of
August and treated at Emory University Hospital, near
the headquarters of the CDC. He had become infected
while working in a Monrovia treatment center as
medical director for the aid group Samaritan’s Purse.
• Nancy Writebol, one of Brantly's missionary
coworkers, became infected at the same time and was
flown to the same hospital

9. EBOLA VIRUS
The virus belongs to Filoviridae family.
There are five identified subspecies :
• Bundibugyo ebolavirus (BDBV)
• Zaire ebolavirus (EBOV): current outbreak
• Sudan ebolavirus (SUDV)
• Taï Forest ebolavirus (TAFV)
• Reston ebolavirus (RESTV): not in humans

10. VIRUS STRUCTURE
• Ebolavirions contain linear nonsegmented, single-strand,
RNA genomes of negative polarity
• Like all filoviruses, ebolavirions are filamentous particles that
may appear in the shape of a shepherd's crook or in the
shape of a "U" or a "6", and they may be coiled, toroid, or
branched.
• Median particle length ranges from 974 to 1,086 nm;
80 nm in width.

11. Clinical presentation
• Symptoms may appear anywhere from 2 to 21
days after exposure to ebolavirus
[8-10 days is MC]

13. Typical symptoms
• Fever
• Headache
• Joint and muscle aches
• Weakness
• Diarrhea
• Vomiting
• Stomach pain
• Lack of appetite

15. How is Ebola transmitted?

16. • Fruit bats of the Pteropodidae family are
considered to be the natural host of the Ebola
virus.

18. Transmission to humans
• The virus is transmitted to people from wild
animals.
• 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,
fruit bats, monkeys, forest antelope and
porcupines found ill or dead or in the rainforest.

19. Transmission among humans
• through direct contact with the blood or bodily
fluids of an infected symptomatic person
• though exposure to objects (such as needles)
that have been contaminated with infected
secretions.
• The viruses often spread through families and
friends because they come in close contact with
infectious secretions when caring for ill persons.

20. Transmission in Health care settings
• During outbreaks of Ebola HF, the disease can spread quickly
within health care settings (such as a clinic or hospital).
• Exposure to virus can occur in health care settings where
hospital staff are not wearing appropriate protective
equipment, such as masks, gowns, and gloves.
• 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. Without adequate sterilization of the
instruments, virus transmission can continue and amplify an
outbreak.

21. Can Ebola be transmitted through the air?
• No. Ebola is not a respiratory disease; not
transmitted through the air.

22. Can we get Ebola from contaminated food or
water?
• No. Ebola is not a food-borne illness.

24. Can we get Ebola from a person who is infected
but doesn’t have any symptoms?
• No. Individuals who are not symptomatic are
not contagious. In order for the virus to be
transmitted, an individual would have to have
direct contact with an individual who is
experiencing symptoms.

25. Diagnosis
• Diagnosing EVD in an individual who has been
infected for only a few days is difficult, because
the early symptoms are non specific.
• However, if a person has the early symptoms of
Ebola HF and there is reason to believe that Ebola
HF should be considered, the patient should be
isolated and public health professionals notified.
Samples from the patient can then be collected
and tested to confirm infection.

26. LABORATORY DIAGNOSIS

27. Treatment
Supportive therapy :
• balancing the patient’s fluids and electrolytes
• maintaining their oxygen status and blood
pressure
• treating them for any complicating infections

28. Prevention
• The prevention of EVD presents many challenges.
• Still unknown how exactly people are infected , there
are few established primary prevention measures.
• When cases of the disease do appear, there is
increased risk of transmission within health care
settings.
• Therefore, health care workers must be able to
recognize a case of EVD and be ready to employ
practical viral hemorrhagic fever isolation precautions
or barrier nursing techniques. They should also have
the capability to request diagnostic tests or prepare
samples for shipping and testing elsewhere.

29. What is CDC doing in the U.S.?
• On the remote possibility that an ill passenger enters the
U.S., CDC has protocols in place to protect against further
spread of disease.
• These include notification to CDC of ill passengers on a
plane before arrival, investigation of ill travelers, and, if
necessary, isolation.
• CDC has also provided guidance to airlines for managing ill
passengers and crew and for disinfecting aircraft.
• CDC has issued a Health Alert Notice reminding U.S.
healthcare workers of the importance of taking steps to
prevent the spread of this virus, how to test and isolate
suspected patients and how they can protect themselves
from infection

30. http://www.bt.cdc.gov/han/han00364.asp

31. Patient Evaluation Recommendations to Healthcare
Providers
• Early recognition is critical for infection control.
Healthcare providers should be alert for and evaluate
any patients suspected of having EVD.

32. Case Definition for EVD
Suspected Case
• Illness in a person who has both consistent symptoms and risk factors as
follows:
1) Clinical criteria :
fever > 38.6 degrees C / 101.5 degrees F, and additional symptoms such
as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or
unexplained hemorrhage;
AND
2) Epidemiologic risk factors within the past 3 weeks before the onset of
symptoms,
- contact with blood or other body fluids of a patient known to have or
suspected to have EVD;
- residence in—or travel to—an area where EVD transmission is active;
- direct handling of bats, rodents, or primates from disease-endemic
areas.
• Malaria diagnostics should also be a part of initial testing.

33. Case Definition for EVD
Confirmed Case
• A suspected case with laboratory-confirmed
diagnostic evidence of ebolavirus infection.

34. Patient Evaluation Recommendations to Healthcare
Providers
CDC recommends testing for all persons with onset of
fever within 21 days of having a high-risk exposure.
Any of the following:
• percutaneous / mucous membrane exposure/ direct skin
contact with body fluids of a person with a confirmed or
suspected case of EVD without appropriate personal
protective equipment (PPE)
• laboratory processing of body fluids of suspected or
confirmed EVD cases without appropriate PPE or standard
biosafety precautions
• participation in funeral rites or other direct exposure to
human remains in the geographic area where the outbreak
is occurring without appropriate PPE.

35. Recommended Infection Control Measures
• Patient placement: Patients should be placed
in a single patient room (containing a private
bathroom) with the door closed.

36. Healthcare provider protection:
• Healthcare providers should wear: gloves, gown
(fluid resistant or impermeable), shoe covers, eye
protection (goggles or face shield), and a
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, and leg
coverings.

37. Aerosol-generating procedures:
• Avoid aerosol-generating procedures. If
performing these procedures, PPE should
include respiratory protection (N95 filtering
facepiece respirator or higher) and the
procedure should be performed in an airborne
isolation room.

38. Environmental infection control
• Diligent environmental cleaning and disinfection and safe handling
of potentially contaminated materials is paramount.
• Appropriate disinfectants : 10% sodium hypochlorite (bleach)
solution, or hospital-grade quaternary ammonium or phenolic
products.
• Healthcare providers performing environmental cleaning and
disinfection should wear recommended PPE and consider use of
additional barriers (e.g., shoe and leg coverings) if needed.
• Face protection (face shield or facemask with goggles) should be
worn when performing tasks such as liquid waste disposal that can
generate splashes.
• Follow standard procedures, per hospital policy and manufacturers’
instructions, for cleaning and/or disinfection of environmental
surfaces, equipment, textiles, laundry, food utensils and dishware.

39. Recommendations to Public Health Officials
• If public health officials have a patient that is
suspected of having EVD or has potentially
been exposed and intends to travel, please
contact CDC’s Emergency Operations Center 1
(770) 488-7100.

40. What is being done to prevent ill passengers in West
Africa from getting on a plane?
• CDC is assisting with active screening and
education efforts on the ground in West Africa to
prevent sick travelers from getting on planes.
• In addition, airports in Liberia, Sierra Leone and
Guinea are screening all outbound passengers for
Ebola symptoms, including fever,.
• Passengers are required to respond to a
healthcare questionnaire.
• CDC is also surging support in the region by
deploying 50 additional workers to help build
capacity on the ground.

41. CDC’s Travel Alert Level 3 ?
• On July 31, the CDC elevated their warning to
U.S. citizens encouraging them to defer
unnecessary travel to Guinea, Liberia, and
Sierra Leone over concerns that travelers may
not have access to health care facilities and
personnel should they need them in country.

42. Thank you.