The document summarizes information about the 2014-2015 Ebola virus outbreak in West Africa, the Ebola virus itself, symptoms and transmission of Ebola virus disease, treatment and prevention. It provides statistics showing over 8,000 cases and 4,800 deaths across Guinea, Liberia and Sierra Leone as of October 2014. The Ebola virus is an RNA virus that causes severe hemorrhagic fever in humans and other primates. Transmission occurs through contact with body fluids of infected people or contaminated materials. There is no approved vaccine but experimental treatments are being developed.

1. Ebola Virus Disease
By
Dr. Rahul Katiyar
Dept. of Community Medicine
KGMU, Lucknow

2. Historical background

3. West Africa Outbreak (2014)
Country Total Cases
Laboratory-
Confirmed Cases Total Deaths
Guinea 1472 1184 843
Liberia 4249 950 2458
Sierra Leone 3252 2849 1183
Total 8973 4983 4484
As of 12 oct 2014 (updated on 15 oct 2014) CDC
Countries with Widespread Transmission

4. Countries with Travel-associated Cases
Country Total Cases
Laboratory-
Confirmed Cases Total Deaths
Senegal 1 1 0
Spain 1 1 0
United States 2 2 1
Total 4 4 1

5. About EBOLA virus
• Characterization of the virus
– Family: Filoviridae
– Genus: Ebolavirus
– Species: Ebola-Zaire, Ebola-Sudan, Ebola-Cote d-Ivoire,
Ebola-Reston
• Morphology under electron microscope
– filamentous, enveloped RNA virus
– approx. 19 kb in length (1 kb = 1000 RNA
bases/nucleotides) or 60-80 nm in diameter
– single-stranded, linear, non-segmented
– negative-sense RNA (encoded in a 3’ to 5’ direction)
– appears to have “spikes” due to glycoprotein on
outside membrane

6. Physicochemical properties:
Stable at room temperature and can resist
desiccation; inactivated at 60°C for 30 minutes;
infectivity greatly reduced or destroyed by UV light
and gamma irradiation, lipid solvents,
b-propiolactone, formaldehyde, sodium
hypochlorite, and phenolic disinfectants

7. Ebola virus disease
• Ebola virus disease (EVD), formerly known as Ebola
haemorrhagic fever, is a severe, often fatal illness in humans.
• Ebola virus disease is a severe disease which affects humans
and other primates, and is a form of viral haemorrhagic
disease.
• The disease was first identified in 1976, However, the largest
ever recorded outbreak is currently underway in three
countries in West Africa, where the virus has not previously
been reported: Guinea, Liberia and Sierra Leone.

8. The source of Ebola
• The exact source of Ebola virus is not known,
However, the virus is thought to come from fruit
bats, and it affects other animals such as
chimpanzees, gorillas, monkeys and porcupines.

9. Transmission to Human
A patient must have symptoms to spread the disease to others
1. Skin (broken) or mucous membrane contact with virus-laden
materials from sick patient
2. Body fluids of a person who is sick or has died from Ebola
(blood, vomit, pee, poop, sweat, semen, spit, other fluids)
3. Objects contaminated with the virus (needles, soiled
clothing, medical equipment)
4. Infected animals (by contact with blood or fluids or infected
meat)
5. The disease can also be transmitted via sexual contact with a
person who is infected or who is recovering from the
disease, as the virus is present in semen for up to 7 weeks
after recovery

10. Once infected
Incubation period of the disease
ranges from 2-21 days

11. Clinical Observations
• Incubation period: 2-21 days
• Stage I (unspecific):
- Extreme asthenia (body weakness)
- Diarrhea, nausea and vomiting, anorexia
abdominal pain
- Headaches
- Arthralgia
- Myalgia (muscular pain or tenderness), back pain
- Mucosal redness of the oral cavity, dysphagia (difficulty in
swallowing)
- Conjunctivitis.
- Rash all over the body except over face
** If the patients don’t recover gradually at this point, there is a high probability
that the disease will progress to the second phase, resulting in complications
which eventually lead to death

12. • Stage II (Specific):
- Hemorrhage
- Neuropsychiatric abnormalities
- Anuria
- Hiccups
- Tachypnea
**Ebola haemorrhagic fever is fatal in between 50-90% of cases
• Late Complications:
- Arthralgia
- Ocular diseases (ocular pain, photophobia & hyperlacrimation)
- Hearing loss
- Unilateral orchitis
**These conditions are usually relieved with the treatment of 1%
atropine and steroids

14. Controlling the spread of Ebola
• a. Hospitals must follow precautionary methods, such as:
1. wearing gloves
2. isolating infected individuals
3. practicing nurse barrier techniques
4. proper sterilization and disposal of all equipment
• b. Burials / cremation must be done correctly
1. no washing or touching carcass
2. put into body bags and bury outside city
• c. Report any questionable illness to officials

16. Guidance for Safe Handling of Human Remains of Ebola
Patient
• Only personnel trained in handling infected human remains, and
wearing PPE, should touch, or move, any Ebola-infected remains.
• Handling of human remains should be kept to a minimum.
• Autopsies on patients who die of Ebola should be avoided. If an
autopsy is necessary, the state health department and CDC should
be consulted regarding additional precaution
• Hermetically sealed casket: A casket that is airtight and secured
against the escape of microorganisms
• Leakproof bag: A body bag that is puncture-resistant and sealed in a
manner so as to contain all contents and prevent leakage of fluids
during handling, transport, or shipping.

18. Diagnosis
• It can be difficult to distinguish EVD from other infectious
diseases such as malaria, typhoid fever and meningitis.
Confirmation that symptoms are caused by Ebola virus
infection are made using the following investigations:
• Antibody-capture enzyme-linked immunosorbent assay
(ELISA)
• Antigen-capture detection tests
• Serum neutralization test
• Reverse transcriptase polymerase chain reaction (RT-PCR)
assay
• Electron microscopy
• Virus isolation by cell culture

19. Treatment and vaccines
• The standard treatment for Ebola remains
supportive therapy.
This includes the following measures:
• Balancing the patient’s fluids and electrolytes
• Maintaining their oxygen status and blood pressure
• Treating them for any complicating secondary
infections.

20. ZMapp, being developed by Mapp Biopharmaceutical Inc.,
is an experimental treatment, for use with individuals
infected with Ebola virus. It has not yet been tested in
humans for safety or effectiveness. The product is a
combination of three different monoclonal antibodies that
bind to the proteins of the Ebola virus

22. • Classified among the highest priority for bioterrorism
agents by the CDC (Category A)
• Ebola Sudan subtype: ~50% mortality rate
• Ebola Zaire subtype: ~80-90% mortality rate