Ebola Virus: the Facts and the Fallacies

USAID/Nigeria Mission Brown-BagMonday August 11, 2014

The Virus: Ebola

• Family: Filoviridae – Marburg and Ebola • Genus: Ebolavirus• Sub-species: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan

ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused disease in nonhuman primates, but not in humans.

The Virus: Ebola

• Spectacular virus – 90% of chances of dying upon contracting it. One of the most lethal viruses. (Co-discoverer of the virus in 1976,Peter Piot)

Transmission

Transmission

Ebola Outbreaks

Current Ebola Outbreak

• First time in west Africa• First time we have epidemic involving several 4 countries • First time it is occurring in capital cities

Nigerian Situation

• 133 suspected cases • 8 diagnosed cases• 2 deaths• Isolation ward established• Screening of travelers in Lagos• Provision of PPE • Volunteer health workers

Symptoms of EVD

• Symptoms of Ebola HF typically include:• Fever• Headache• Joint and muscle aches• Weakness• Diarrhea• Vomiting• Stomach pain• Lack of appetite

Symptoms of EVD• Some patients may experience:• A Rash• Red Eyes• Hiccups• Cough• Sore throat• Chest pain• Difficulty breathing• Difficulty swallowing• Bleeding inside and outside of the bodySymptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.Some who become sick with Ebola HF are able to recover, while others do not. The reasons behind this are not yet fully understood. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.

Possible Signs and Symptoms

Diagnosis

Timeline of Infection Diagnostic tests available

Within a few days after symptoms begin •Antigen-capture

enzyme-linked immunosorbent assay (ELISA) testing•IgM ELISA•Polymerase chain reaction (PCR)•Virus isolation

Later in disease course or after recovery •IgM and IgG

antibodies

Retrospectively in deceased patients •Immunohistochemistr

y testing•PCR•Virus isolation

Laboratory tests used in diagnosis include:

Viral Isolation

Prevention in the Lab

Case Definition• Case Definition for Ebola Virus Disease (EVD) (Updated: August 7, 2014)• Person Under Investigation (PUI)• A person who has both consistent symptoms and risk factors as follows: 1)

Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats, rodents, or primates from disease-endemic areas.

• Probable Case• A PUI who is a contact of an EVD case with either a high or low risk exposure

(see below).• Confirmed Case• A case with laboratory confirmed diagnostic evidence of ebola virus infection.• Contacts of an EVD Case

Case Definition contd.• Contacts of an EVD case have different levels of exposure risk, as follows:

• High risk exposures• A high risk exposure includes any of the following:• Percutaneous, e.g. the needle stick, or mucous membrane exposure to body fluids of EVD patient• Direct care or exposure to body fluids of an EVD patient without appropriate personal protective

equipment (PPE)• Laboratory worker processing body fluids of confirmed EVD patients without appropriate PPE or standard

biosafety precautions• Participation in funeral rites which include direct exposure to human remains in the geographic area where

outbreak is occurring without appropriate PPE• Low risk exposures• A low risk exposure includes any of the following• Household member or other casual contact1 with an EVD patient• Providing patient care or casual contact1 without high-risk exposure with EVD patients in health care

facilities in EVD outbreak affected countries*

• No known exposure• Persons with no known exposure were present in an EVD outbreak affected country* in the past 21 days

with no low risk or high risk exposures.

Treatment for EVD

• Standard treatment for Ebola HF is still limited to supportive therapy. This consists of:

– balancing the patient’s fluids and electrolytes– maintaining their oxygen status and blood pressure– treating them for any complicating infections

• Timely treatment of Ebola HF is important but challenging since the disease is difficult to diagnose clinically in the early stages of infection. Because early symptoms such as headache and fever are nonspecific to ebolaviruses, cases of Ebola HF may be initially misdiagnosed.

Prevention Strategies

Information Dissemination

Prevention

• Very Basic sanitary measures can control it

• Not transmitted through droplets• Ebola virus is not spread through casual

contacts• Food • water

Prevention

• Health Care workers must wear protective gear

Prevention

Prevention

• Isolation ward for the sick

Prevention

• Consumption of bush meat – the facts!

Prevention

• Handling of Corpses – the facts!

Prevention

• Appropriate and regular hand washing.

What is Handwashing?

• Handwashing is the act of cleansing the hands with water and soap, for the purpose of removing soil, dirt, and/or micro-organisms

What is Handwashing?

• Handwashing is the act of cleansing the hands with water and soap, for the purpose of removing soil, dirt, and/or micro-organisms

Important steps for good hand hygiene

Wash your hands with soap and water or sanitize your hands with an alcohol-based hand sanitizer:• Before preparing food• Before eating• Before and after caring for someone that is sick• After using the bathroom• After sneezing or coughing• After touching anything that may be a transmission vector of

infection causing germs, such as toys, doorknobs, railings, grocery carts, diapers, raw food, animals and trash.

Alert!

• According to the Centers for Disease Control and Prevention (CDC), if you don't wash your hands frequently, you can pick up germs from other sources and then infect yourself. You're at risk every time you touch your eyes, nose, or mouth. By frequently washing your hands the right way, you'll wash away germs — such as bacteria and viruses — that you have picked up from other people

• Ebola virus can be prevented simply with soap and water.

Focus the Attention on Children• We recognize the potential of children as change

agents of hand washing behavior. Please teach your children and domestic help the importance of hand-washing. Make all kids partners in Hand washing

The power of handwashing is in our hands

Good Procedure

• A good procedure is to wet hands with water, apply enough soap to create a lather to cover all hand surfaces, rub hands palm to palm and carefully scrub fingers, back and front of hands and each thumb. Rinse hands with water and gently dry hands with a clean paper towel. Turn off the tap with paper towels to prevent re-contamination of hands. The entire hand-washing process should take at least 20 seconds or the amount of time to sing Happy Birthday twice

IMPORTANT NOTICE!!!