- Ebola virus disease is a severe and often fatal illness in humans and nonhuman primates, with a high fatality rate of up to 90%. - The virus is transmitted through contact with bodily fluids of infected animals or humans. During the 2014 outbreak in West Africa, over 17,000 cases were reported in Guinea, Liberia and Sierra Leone. - There is no approved vaccine or treatment, so care is supportive to maintain hydration and treat symptoms. Isolating patients suspected of infection and proper disposal of contaminated materials is crucial to control spread of the disease.

1. EBOLA
HEAMORRAGIC FEVER
BY – Dr Yusuf Imran
MBBS, MD
New Delhi, India

2. INTRODUCTION

3. • Ebola Virus Disease is a Severe, often fatal illness, with a death of up to
90%. The illness affects humans and nonhuman primates.
• Mainly a disease of primates like Fruit Bats, Chimpanzees , Gorilla ,Monkeys
• EVD spreads from an infected sick person to others when there is direct
contact with bodily fluids

4. • Ebola virus was isolated in 1976 near the Ebola river in Congo
• Most prevalent in Zaire and southern Sudan
• Attack rate is highest in < 1 yrs and 15 to 50 yrs of age

5. • West Africa in 2014 suffered largest outbreaks in which 17,900 cases were
reported
• In 2014 sporadic outbreaks occured in Guinea , Liberia , Sierra Leone ,
Nigeria

7. The virus belong to
FILOVIRIDAE family
In general, ebolavirions
are 80 nanometers (nm)
in width and may be as
long as 14,000 nm.

8. VIRUS STRUCTURE
• Single stranded , linear , non segmented , negative – sense RNA virus
• Appears to have “spikes” due to glycoprotein on outside membrane
• Therefore , spreads rapidly.

9. EBOLA SUBSPECIES
Ebola virus has 5 identical sub species
• Bundibugyo ebolavirus (BDBV)
• Zaire ebolavirus (EBOV)
• Sudan ebolavirus (SUDV)
• Tai Forest ebolavirus (TFEV)
• Reston ebolavirus (RESTV)

10. CLINICAL PRESENTATION

11. • Symptoms may appear anywhere from 2 to 21 days after exposure to ebola
virus
• ( 8 to 10 ) days are most common.

12. TYPICAL SYMPTOMS
• Fever ( > 101.5 F)
• Headache
• Joint and muscle pain
• Weakness
• Diarrhoea
• Vomiting
• Stomach pain
• Lack of appetite

13. SOME PATIENTS MAY EXPERIENCE
• A rash
• Red eyes
• Coughs
• Sore throat
• Chest pain
• Difficulty breathing
• Bleeding inside and outside of body

15. • Bleeding manifestation such as petechiae
and haemorrhage occurs in more then half of patients
• Central nervous system manifestation characterised by Somnolence, delirium
and coma

16. HOW IS EBOLA TRANSMITTED

17. • Fruit Bat of Pteropodidae family are considered to be the natural host of
Ebola virus

19. TRANSMISSION TO HUMANS
• The virus is transmitted to humans from wild animals
• Ebola is introduced through close contact with blood , secretions ,organ , or
other bodily fluids of infected animals
• In Africa , infection has been documented by the handling of infected
chimpanzees , fruit bats , monkeys , forest antelope

20. Bushmeat being prepared for cooking
in Ghana. In Africa, wild animals including
fruit bats are hunted for food and are
referred to as bushmeat. In equatorial
Africa, human consumption of bushmeat
has been linked to animal-to-human
transmission of diseases, including Ebola.

21. TRANSMISSION AMONG HUMANS
• Through direct contact with the blood or bodily fluids of infected
symptomatic person
• Through exposure to objects such as needle contaminated with infected
secretions
• Through sexual contacts or kissing because semen and saliva is also infective

22. TRANSMISSION IN HEALTH CARE
SETTING
• Exposure to virus can occur in hospital staff if they are not wearing
appropriate protective equipment such as mask , gowns and gloves
• Proper cleaning and disposal of instruments , such as needles and syringes is
important
• Proper sterilization of instrument

24. DIAGNOSIS

25. Diagnosis
• Diagnosing early Ebola infection is difficult because the symptoms are non
specific
• However if the person has 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. Diagnosis
• Non-specific laboratory indicators of EVD include
low platelet count
an initially decreased WBC count followed by an increased WBC count
elevated liver enzymes ALT and AST
abnormalities in blood clotting often consistent with DIC such as a
prolonged PT, APTT, and bleeding time.

28. MANAGEMENT

29. MAKING ECUs/CCCs
• These centres enable infected persons to receive basic, curative and palliative
care along with access to essentials including food, drink, clean clothing and
linens, while being isolated.
• It also reduce the transportation of patient and hence spread.

30. TRIAGE IN ECUs/CCCs
• Patients with suspected Ebola are isolated from others who do not have
Ebola to reduce the risk of transmission.
• Patients with suspected Ebola who need treatment can receive it quickly, to
improve their chance of survival;

31. PATIENT PRESENTS WITH
• Fever + contact = Suspected case – admit to ECU/CCC
• Fever + symptoms = Suspected case – admit to ECU/CCC
• Contact + symptoms = Suspected case – admit to ECU/CCC

32. PATIENT PRESENT WITH
• Fever only No other symptoms or contact = Not suspected case – go home
and monitor health
• Contact only No fever or other symptoms = Not suspected case – go home
and monitor health
• Symptoms only No fever or contact = Consider other causes and refer to
appropriate health facility if needed

33. CONTACT WITH EBOLA
In the past 3 weeks, has the person:
• Cared for sick person ?
• Washed the clothes of the person who was sick or dead
• Had sexual contact with person who has since died
• Touched the dead body
• Washed the dead body
• Touched a sick animal ( monkey , fruit bat )

34. SYMPTOMS INCLUDE ANY 3 OF
• DRY SYMPTOMS : - headache , extreme tiredness , loss of appetite ,
nausea, stomach pain , sore throat , breathing difficulty , muscle and joint
pain , red eyes , rash , hiccups
• WET SYMPTOMS : - diarrhoea, vomiting, bleeding (in vomit, stool or
urine), foetal loss, unusual or non-traumatic bleeding.

35. Treatment
• No specific drug or vaccine available
• Only supportive treatment available
• Maintain hydration and blood pressure by giving ORS/IVF
• Maintain oxygen saturation of blood > 90 % by giving oxygen or putting on
ventilators
• Correct any electrolyte imbalance

36. Treatment
• If bleeding occurs fresh whole blood can be given
• Antibiotics can be given for prevention of supernatant bacterial infection
• Good nursing care

37. Preventive strategies: Indian govt.
• All flights flying to India from West African countries should have an in flight
announcement informing travelers about Ebola symptoms and instructions to
follow on arrival & during flight.
• 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.

38. Preventive strategies: Indian govt.
• Follow aircraft disinsection / disinfection procedures (as recommended by
WHO/ICAO).

39. Status of Ebola in India
• An Indian resident who tested positive for Ebola—and was cured—landed
in Delhi from Liberia in Nov,2014.
• The 26-year-old man was isolated in a facility at Delhi’s Indira Gandhi
International airport.
• His blood tested negative in India. The patient was kept in isolation in a
health facility at the airport until his semen tested negative (upto 3 months).

40. Current Status in World
• A total of 28,616 Ebola cases have been reported in Guinea, Liberia and Sierra Leone, with
11,310 deaths.
• On 29 December 2015, 42 days after the last person tested negative for a second time,
Guinea was declared free of Ebola transmission. At that time, a 90-day period of
heightened surveillance was announced.
• Dec, 2015 was the first time when that all three countries – Guinea, Liberia and Sierra
Leone – had stopped the original chains of transmission.
• It reoccurred in Sierra Leone on 14 January 2016. It was declared no longer an emergency
on 29 March 2016.

41. THANK YOU