EBOLA VIRUS,OUTBREAK,INCUBATION,FEVER,TREATMENT.

1.  Presented by:
HEENA PARVEEN,
B.Pharmacy
Dhanavanthri College of Pharmacy,
MBNR.
1

2. Introdruction
 Ebola virus (EboV) is a highly pathogenic
enveloped virus that causes outbreaks of
zoonotic infection in Africa.
 EVD is a severe acute viral illness, characterized
by acute onset of fever, malaise, myalgia,
headache, and pharyngitis followed by vomiting,
diarrhea, maculo-papular rash, limited renal and
hepatic involvement and hemorrhagic diathesis.
Incubation period ranges between 2 – 21 days.

3. Introduction
 Ebola virus infection was observed in
carcasses of gorilla, chimpanzee during
outbreaks in 2001, which became the source
of human infection. Bats are also considered
as a possible reservoir of infection.
 The main targets of infection are endothelial
cells, mononuclear phagocytes and
hepatocytes.

4. 1976- First Major Outbreak
(ZEBOV)
1976- Sudan (SEBOV)
Occur Sporadically

5. 2002- Fruit Bats
Antibodies against Ebola
Ebola Gene sequences in liver
and spleen
Fruit bats do not show any
symptoms
Best candidate to be the
reservoir
More research needs to be done

6.  The link between human infection by the
Ebola virus and their proximity to primates is
clear.
-Outbreaks occurred in countries that house
80 percent of the world’s remaining wild
gorilla and chimpanzee populations.
- The outbreaks coincided with the
outbreaks in wild animals.
- The same distinct viral strains were
isolated in animal carcasses and in the bodies
of those who handled those carcasses.
- These outbreaks were preceded by an
abnormally large death in wild Gorilla
populations.

7. Distribution of EVD cases by affected areas and confirmation status,
as of 7 April 2014

8. .Zaire (Democratic
.Republic of the Congo)
Ebola-Zaire
.Sudan
Ebola-Sudan
.Gabon
.Ivory Coast
Ebola-Cote d’Ivoire
.Uganda
.Republic of the Congo
(not the DRC)

9.  Ebola Virus.
 Family: Filoviridae;
 Genus: Ebola virus

10.  Virion morphology and size: Enveloped,
helical, cross-striated nucleocapsid,
filamentous or pleomor- phicvirions that are
flexible with extensive branching,
 80 nm in diameter and 970-1200 nm in
length.

11.  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

12.  Structure of Ebola genome and proteins
 Transcribed into 8 sub-genomic mRNA proteins:
7 structural and 1 non-structural
 7 structural proteins:
 nucleoprotein (NP)
 4 viral/virion proteins (VP35, VP40, VP30, VP24)
 glycoprotein (GP)
 RNA-dependent RNA polymerase (L protein)
 NP, VP35, VP30, L protein: required for transcription &
replication
 VP40, GP, VP24: associated with the membrane

13. PROTEINS

14. Ebola Hemorrhagic Fever was first found in 1976
It struck two countries within that year
a. Sudan – in a town called N’zara
b. Zaire, now known as the Democratic Republic of
Congo
In these two instances the mortality rate was between
50 –90%
Following those epidemics, Ebola hit Africa in many
other instances the worst yet being in the year 2000
when it struck Uganda infecting more than 400 people

15. Trasmission
Ebola-Reston has shown to be airborne
The other three strains are transmitted by
contact of any kind (fluids or skin)
Target groups
Anyone who comes in contact with an infected
animal or person is at high risk of contacting
the disease.
However, some people seem to have natural
defenses in their immune system that allow
their bodies to kill the virus. Scientists do
not know exactly how this occurs

16. Target Organs and Damage Methods
Target mainly small capillary vessels. Attach to
walls, cause leakage of blood and serum into
surrounding tissue.
When white blood cells attack the virus, they dissolve
– this releases a chemical into the blood stream that
signals the release of other chemicals (pro-
inflammatory cytokines, pro-coagulants, and
anticoagulants)
These injure blood vessels even worse, resulting in
permanent bleeding.
Eventually, the entire body is leaking and dissolving

18.  Incubation Period: Anywhere from 2-21 days
As it progresses:
 Severe vomiting
 Abdominal pain
 Diarrhea
 Pharyngitis
 Conjunctivitis
 External bleeding
 Extremely high body temperature
 Prostration
Symptoms:
Severe headache
Weakness
Muscle aches

20. Diagnosis continued.
Advanced Stage Testing:
-Test for IgM and IgG anitbodies.
Retrospective Testing:
-Immuno histochemistry testing
-Virus isolation
(Occur after death)

21.  THERE IS NO CURE FOR EBOLA HF
 Care of infected persons:
-Supportive therapy -Maintain Oxygen status,BP
-Balance Fluids & Electrolytes. -Treatment of complicating
infections
Experimental Treatment:
-In the Kikwit outbreak in DRC, doctors transmitted blood
from survivors to sufferers, hoping to transmit whatever
antibodies helped them survive.
It is unknown whether or not survivors gain immunity from
infection. Doctors believe it is possible, but because of the
limited ability to test this theory, it remains to be seen.

22. Prevention
Classified as Biosafety level 4
(greatest threat to humans)
Extensive precautions taken when dealing
With suspected cases to limit transmission
Several layers of protective clothing
covering entire body (up to four).
Complete equipment sterilization
Quarantine of Ebola HF patients

23. Prevention & Control
 Avoid contact with host species
 Rodents
 Control rodent populations
 Discourage rodents from entering or living in human
populations
 Safe clean up of rodent nests and droppings
 Insects
 Use insect repellents
 Proper clothing and bed nets
 Window screens and other barriers to insects

24.  Prevention & control
 Vaccine available for Yellow fever
 Experimental vaccines under study
 Argentine HF, Rift Valley Fever, Hantavirus and
Dengue HF
 If human case occurs
 Decrease person-to-person transmission
 Isolation of infected individuals

25.  Prevention & control
 Protective clothing
 Disposable gowns, gloves, masks and shoe covers,
protective eyewear when splashing might occur,
or if patient is disoriented or uncooperative
 WHO and CDC developed manual
 “Infection Control for Viral Hemorrhagic Fevers
In the African Health Care Setting”

26. Protective equipment worn by a
nurse during Ebola outbreak in Zaire,
1995

27.  Prevention & Control
 Anyone suspected of having a VHF must use a
chemical toilet
 Disinfect and dispose of instruments
 Use a 0.5% solution of sodium hypochlorite (1:10
dilution of bleach)

28. Future outlook
A study released in December of 2003 showed that
researchers studying infected monkeys have
found a way to increase survival rates
100% of infected monkeys had been dying
These were injected with rNAPc2, a factor known
to inhibit blood coagulation, a characteristic of
Ebola HF.
33% of these monkeys survived and regained
health. All untreated monkeys died.
rNAPc2 is known to be relatively safe in humans –
this method is being studied further.