Ebola the deadly african virus

2. The Deadly African Virus

3. By
Dr.Ashraf Eladawy
Consultant Chest Physician
TB TEAM EXPERT – WHO
Mansoura -Egypt

4. 4

7. 7

8. 8

9. 2014

10. EBOLA OUTBREAK 2014

12. 2014

22. Saudi Arabia Bans Haj Pilgrims From
Ebola Hit Countries- August 4, 2014

24. The world's worst outbreak of
Ebola that has killed nearly
1,000 people in West Africa
represents an international
public health emergency
8 August 2014

25. Ebola Virus Disease

26. Ebola: WHO declares the epidemic
as global emergency
US health authorities had admitted that Ebola's
spread beyond west Africa was inevitable.
Even medical charity Doctors Without Borders
had warned that the deadly virus was now "out
of control" with more than 60 outbreak hotspots

27. Egypt hospitals on alert for Ebola
Aug. 09, 2014

28. من ناحيتها أعلنت وزارة الصحة والسكان خلو مصر من أية حالات مشتبهة أو
مؤكدة لمرض "إيبولا" حتى الآن، مشيرة إلى اتخاذ قطاع الشئون الوقائية
والمتوطنة عدد من الإجراءات الوقائية في إطار المتابعة اليومية للموقف
الوبائي العالمي للمرض
وبدأت سلطات الحجر الصحي في مطار القاهرة تشديد الإجراءات الوقائية للركاب
القادمين من دول غرب إفريقيا، عن طريق مباشر أو غير مباشر
وأكد مدير الحجر الصحي في مطار القاهرة
أن الاجراءات التى سيتم اتخاذها تتضمن تحرير بطاقات صحية للقادمين من هذه
الدول تشمل كافة البيانات عنهم، وإرسالها للمديريات الصحية في المحافظات
لمتابعة الراكب لمد 21 يوما بعد وصوله، الحميات

29.  In the case of a suspected infection, a patient would
be transported to the Abasseya Fever hospital,
which has been equipped with all equipments
required to handle such cases
 Egypt’s Health Ministry has warned Egyptians from
travelling to West Africa, especially Sierra Leone,
Nigeria and Liberia where several cases of Ebola
have been reported.

30. استعدادات مكثفة بالدقهلية لمواجهة موسم
إصابات الجهاز التنفسى والإيبولا
27.08.2014

31. قال اللواء عمر الشوادفي محافظ الدقهلية، إن مديرية الصحة
بالدقهلية اتخذت كافة الإجراءات سواء من تدريب أو توفير
مستلزمات أو مطبوعات لمواجهة موسم إصابات الجهاز
التنفسي و الايبولا فى

35. Definition
 Ebola virus disease (formerly known as Ebola
hemorrhagic fever) is:
– A disease caused by the Ebola virus
– Is severe- fatality rate 90%
– Affects human and non human primates
(such as monkeys, gorillas, and chimpanzees)

36. History of Ebola virus
 Ebola first appeared in 1976 in two simultaneous
outbreaks.
 In Nzara , small town in southern Sudan.
 In Yambuku, in the Democratic Republic of Congo
(Zaire) , The latter was a village situated near the
Ebola River, from which the disease takes its name

38. Zaire = Democratic republic of congo

39. AlvinChew slideshare presentation
alvinworks2006@yahoo.com

40. History of Ebola virus
Ebola first appeared in 1976 in 2 simultaneous
outbreaks, first in Nzara , in south of Sudan
which infected over 284 people, with a mortality
rate of 53%.
Another out break occurred in Yambuku in
Democratic Republic of Congo , which infected
318 people with highest mortality rate of 88% .

41. Ebola Outbreaks
 24 outbreaks reported by WHO from 1976 till
2012 . No case reported out of Africa till 2012 .
 Epidemics of Ebola virus have occurred mainly
in African countries:
1. Democratic Republic of Congo ( Zaire )
2. Sudan
3. Gabon
4. Uganda
5. Côte d’Ivoire ( one case in 1994)
6. South Africa ( one case in 1996 )

42. Natural Habitat = Africa
 Zaire (Democratic
Republic of the Congo)
 Sudan
 Gabon
 Ivory Coast
 Uganda
 Republic of the Congo
(not the DRC)
Ivory Coast
Gabon
Congo
DRC
Sudan
Uganda

44. Cases of Ebola Hemorrhagic Fever in Africa,
1976 - 2008
Country Town Cases Deaths Species Year
Dem. Rep.
of Congo
Yambuku 318 280 Ezaire 1976
Sudan Nzara 284 151 Esudan 1976
Dem. Rep.
Tandala 1 1 Ezaire 1977
of Congo
Sudan Nzara 34 22 Esudan 1979
Gabon Mekouka 52 31 Ezaire 1994
Ivory Coast Tai Forest 1 0
EIvoryCoa
st
1994
Dem. Rep.
of Congo
Kikwit 315 250 Ezaire 1995
Gabon Mayibout 37 21 Ezaire 1996

45. Gabon Booue 60 45 Ezaire 1996
South Africa Johannesburg 2 1 Ezaire 1996
Uganda Gulu 425 224 Esudan 2000
Gabon Libreville 65 53 Ezaire 2001
Republic of
Not
57 43 Ezaire 2001
Congo
specified
Republic of
Congo
Mbomo 143 128 Ezaire 2002
Republic of
Congo
Mbomo 35 29 Ezaire 2003
Sudan Yambio 17 7 Esudan 2004
Dem. Rep. of
Congo
Luebo 264 187 Ezaire 2007
Uganda Bundibugyo 149 37 Ebundi 2007
Dem. Rep. of
Congo
Luebo 32 15 Ezaire 2008

46. AlvinChew slideshare presentation
alvinworks2006@yahoo.com

48. 2014 Ebola Outbreak in West
Africa
The 2014 Ebola outbreak is one of the largest
Ebola outbreaks in history and the first in West
Africa.
It is affecting five countries in West Africa:
1. Guinea
2. Liberia
3. Sierra Leone
4. Nigeria
5. DRC

49. 2014 Ebola Outbreak in West Africa - Outbreak
Distribution Map

50. 2014 Ebola Outbreak in West Africa - Outbreak
Distribution Map

52. 5

54. WHO , August 28 , 2014
The latest World Health Organization data on
2014 Ebola outbreak in West Africa shows 3,069
probable and confirmed cases and 1,552 deaths.
The number of cases continues to accelerate,
with 40 percent of the total cases occurring in
the last 21 days.
It is the deadliest outbreak of Ebola in history.

55. The total impact of previous recorded outbreaks
— from 1976 to 2013 — included 2,357 cases and
1,548 deaths, according to the CDC.
The WHO predicts the disease is going to
continue to rip through Africa for another six to
nine months, though the organization has vowed
to stop the outbreak within that time.

56. The assessment came as the W.H.O. presented
what it called a road map for stopping the
transmission of Ebola within six to nine months.
The plans are likely to cost nearly half a billion
dollars over the next six months.
Though the road map aims to stop the epidemic
in that time frame, “We have to be realistic that
there is uncertainty” about such targets.
Bruce Aylward, an assistant director general of the health organization

57. Ebola Could Eventually Afflict More
Than 20,000, W.H.O. Says
 The World Health Organization said that the
Ebola epidemic was still accelerating and
could afflict more than 20,000 people —
almost seven times the current number of
reported cases — before it could be brought
under control
WHO , August 28 , 2014

58. Senegal confirms its first Ebola case, a
university student from Guinea
29 August 2014

59. Senegalese health minister Awa Marie
confirm the frist case of Ebola in Senegal
on Aug. 29 in Dakar

60. Senegal urgently needs supplies
to stop Ebola, WHO says
 The effort to contain Ebola in Senegal is “a top
priority emergency,” WHO said
 The government continued tracing everyone who
came in contact with a Guinean student who has
tested positive for the deadly disease in the
capital, Dakar.
 Senegal faces an “urgent need” for support and
supplies including hygiene kits and personal
protective equipment for health workers, the
WHO said .

62. Genus of Ebola Virus

64. 5 Species of ebola virus
1. Bundibugyo (Uganda)
2. Zaire ( Democratic Republic of
Congo)
3. Sudan
4. Côte d’Ivoire (Taï Forest ebolavirus )
5. Reston

66.  Bundibugyo , Zaire and Sudan Ebola virus
species are associated large Ebola virus
disease outbreaks in Africa with high case
fatality ratio (25–90%) .
 Reston ebolavirus (RESTV) and Taï Forest
ebolavirus (TAFV) , formerly Côte d’Ivoire have
not associated with EVD in Africa .

67. The Reston ebolavirus (RESTV ), found in
Philippines and the People’s Republic of China,
can infect humans, but no illness or death in
humans from this species has been reported to
date. , has only caused asymptomatic illness
Reston ebolavirus , has caused disease in
nonhuman primates, but not in humans.

68. 2014 Ebola Outbreak in West Africa
 Genetic analysis of the virus indicates that it
is closely related (97% identical) to variants
of Ebola virus (species Zaire ebolavirus)
identified earlier in the Democratic Republic
of the Congo and Gabon

70. Natural host of Ebola virus
 In Africa, Fruit bats of the Pteropodidae
family are considered to be the possible
natural host of the Ebola virus

72.  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.

73.  Scientists now believe that bats are the natural
reservoir for the virus, and that apes and humans
catch it from eating food that bats have drooled or
defecated on, or by coming in contact with
surfaces covered in infected bat droppings and
then touching their eyes or mouths.
 The current outbreak seems to have started in a
village near Guéckédou, Guinea, where bat
hunting is common, according to Doctors Without
Borders.

76. The infection of human cases with Ebola virus
through the handling of infected chimpanzees,
gorillas, and forest antelopes – both dead and
alive – has been documented in Côte d'Ivoire,
the Republic of Congo and Gabon.
The transmission of the Ebola Reston strain
through the handling of cynomolgus monkeys
has also been reported.

78. The manner in which the virus first appears in a
human at the start of an outbreak is unknown.
However, researchers have hypothesized that
the first patient becomes infected through
contact with an infected animal .
Researchers believe that the virus is zoonotic
(animal-borne) with fruit bats being the most
likely natural reservoir.

79. Bats are strongly implicated as both
reservoirs and hosts for the ebolavirus.
Initial infections in humans result from
contact with an infected bat or other wild
animal
The Ebola virus is transmitted to people from
wild animals and spreads in the human
population through human-to-human
transmission.

84.  Host immune responses to Ebola virus and cell
damage due to direct infection of monocytes and
macrophages cause the release of cytokines
associated with inflammation and fever.
 Infection of endothelial cells also induces a
cytopathic effect and damage to the endothelial
barrier that, together with cytokine effects, leads
to the loss of vascular integrity.

85.  The cytopathic effect,
from infection in the
endothelial cells,
results in a loss of
vascular integrity
 Damage to the liver
leads to coagulopathy
08/21/2014 Dr. Vaibhav V. Rajhans 85

88. Infection And The Immune Response
Instead of hiding from your immune system
Ebola Virus (EBOV) infects cells of your
immune system first
Once the virus infects your immune cells and
begins to replicate, it evolves to have an
affinity for other cell types, especially
liver cells.

89. Pathogenic Mechanisms
• EBOV has two main, and complementary,
pathogenic mechanisms that make it so deadly:
 It turns on the inflammatory response full-blast.
This results in increased vascular permeability,
hemorrhage, shock, and ultimately, death.
 It turns off the activation of virus-specific
immune responses so you get little-to-no anti-viral
immunity to control the replication of the
virus inside your body.

90. Ebola Infection Domino Effect
 EBOV infects Dendritic Cells , monocytes, and
macrophages , and also activates neutrophils.
These are all cells belonging to your early or
“innate” immune system, which is your front-line
defense against foreign invaders.
 These events cause the release of massive
amounts of pro-inflammatory cytokines such as
TNFa, which increase vascular permeability, fluid
leakage, and shock. This effect is known as
“cytokine storm”.

91. Tissue Factor is also produced, which disrupts
normal blood clotting and contributes to
hemorrhaging.
 Virus replication escalates in the infected cells
 In the infected cells, the production of interferon-gamma
(IFNg) is turned off.
Downstream interactions of DCs and MO with
lymphocytes (T cells and B cells) to initiate an
anti-viral immune response, which are dependent
on IFNg, are disrupted.

92. 5 The maturation of DCs into functional antigen-presenting
cells is inhibited, which, along with the
decrease in IFNg, blocks activation of T cells and
B cells preventing development of virus-specific
immunity.
6 Virus replication is rampant in infected cells
resulting in rapid spread internally, high viral
loads, and nothing to keep the virus in check

93. 7 The virus spreads to other cell types, in
particular liver cells, eventually leading to liver
failure, increasing the potential for
hemorrhaging.
8 Once symptoms appear, death typically occurs
within 7-14 days. If the patient survives, recovery
can be a very long and difficult process.

95. Transmission of EVD
 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,
monkeys, forest antelope, porcupines and fruit
bats found ill or dead or in the rainforest.

97. African brush-tailed porcupine sold for meat in
Cameroon

102. Transmission of EVD
Generally, a person must come into contact
with an animal that has Ebola and it can then
spread within the community from human to
human.

103. Transmission of EVD
In the 2014 Ebola outbreak, nearly all of the
cases of EVD are a result of human- to-human
transmission (H2H) .
Person-to-person transmission is the means
by which outbreaks and epidemics progress

104. Transmission of EVD
 Ebola spreads in the community through
human-to-human transmission .
 Infection result from direct contact (through
broken skin or mucous membranes) with the
blood, secretions, organs or other bodily fluids
of infected people, and indirect contact with
environments contaminated with such fluids.

105. When an infection does occur in humans, the
virus can be spread in several ways to others.
The virus is spread through direct contact
(through broken skin or mucous membranes)
with
1. A sick person's blood or body fluids (urine,
saliva, feces, vomit, and semen)
2. Objects (such as needles , soiled clothing, bed
linen ) that have been contaminated with
infected body fluids
3. Infected animals

107. AlvinChew slideshare presentation
alvinworks2006@yahoo.com

108. Ebola is not spread through the air or by
water or, in general, by food
 However, in Africa, Ebola may be spread as a
result of hunting, processing and consuming
infected animals (e.g. bushmeat ).

109. Transmission of EVD
Additional transmission has occurred in
communities during funerals and burial
rituals.
Burial ceremonies in which mourners have
direct contact with the body of the deceased
person have played a role in the
transmission of Ebola.

110. Persons who have died of Ebola must be
handled using strong protective clothing and
gloves and must be buried immediately.
WHO advises that the deceased be handled
and buried by trained case management
professionals, who are equipped to properly
bury the dead.

114. During outbreaks of Ebola HF, the disease can
spread quickly within health care settings.
Exposure to ebolaviruses can occur in health
care settings where hospital staff are
 Not wearing appropriate PPE (personal
protective equipments ) or
 Not properly applying infection prevention and
control measures when caring for the patients.

115. Health-care workers have frequently been
infected while treating patients with suspected
or confirmed EVD.
Healthcare providers at all levels of the health
system – hospitals, clinics, and health posts –
should be briefed on the nature of the disease
and how it is transmitted, and strictly follow
recommended infection control precautions

116. WHO does not advise families or communities
to care for individuals who may present with
symptoms of Ebola virus disease in their
homes.
 Rather, isolated , seek treatment in a hospital .

118. Proper
Clothing

120. Medical
personnel
aiding in
ZAIRE

121. VICTIM OF
EBOLA ZAIRE

123. Ebola is extremely infectious, because a very
small amount can cause illness , so people who
are infected are highly likely to get sick. But it's
not highly contagious.
You are not likely to catch Ebola just by being in
proximity with someone who has the virus; it is
not airborne, like the flu or respiratory viruses
such as SARS.
Instead, Ebola spreads through direct contact
with bodily fluids.

124. Who is most at risk?
 During an Ebola outbreak, those at higher
risk of infection are:
 Health care workers
 Family members or others in close contact
with infected people
 Mourners who have direct contact with the
bodies of the deceased as part of burial
ceremonies.

125. Unprecedented number of medical
staff infected with Ebola
The outbreak of Ebola virus disease in west
Africa is unprecedented , including the high
proportion of doctors, nurses, and other health
care workers who have been infected.
To date, more than 240 health care workers have
developed the disease in Guinea, Liberia,
Nigeria, and Sierra Leone, and more than 120
have died.
Situation assessment - 25 August 2014

127. Incubation period
The incubation period from time of infection
with the Ebola virus to appearance of symptoms
associated with the disease is as short as 2
days to as long as 21 days.
Symptoms may appear any where from 2 to 21
days after exposure to ebolavirus, although
8-10 days is most common.
 A person infected with Ebola virus is not
contagious until symptoms appear.

139. Ebola Virus Disease

140. Ebola Virus Disease

141. Ebola Virus Disease

143. EBOLA VICTIM

148. Diagnosis
Ebola virus infections can be diagnosed
definitively in a laboratory through several
types of tests:
1) Antibody-capture enzyme-linked immunosorbent
assay (ELISA)
2) Antigen detection tests
3) Serum neutralization test
4) Reverse transcriptase polymerase chain reaction
(RT-PCR) assay
5) Electron microscopy
6) Virus isolation by cell culture.

150.  Samples from patients are an extreme biohazard
risk; testing should be conducted under maximum
biological containment conditions.
 People are infectious as long as their blood and
secretions contain the virus..
 For this reason, infected patients receive close
monitoring from medical professionals and
receive laboratory tests to ensure the virus is no
longer circulating in their systems before they
return home

151. Men who have recovered from the illness can
still spread the virus to their partner through
their semen for up to 7 weeks after recovery.
For this reason, it is important for men to
avoid sexual intercourse for at least 7 weeks
after recovery or to wear condoms if having
sexual intercourse during 7 weeks after
recovery.

152. Treatment
No specific treatment is available .
 Standard treatment for Ebola HF is still
limited to supportive therapy consists of :
 Balancing the patient’s fluids and electrolytes
Maintaining their oxygen status and blood
pressure
Treating them for any complicating infections .

153. Vaccine
No licensed vaccine for EVD is available.
Several vaccines are being tested, but none
are available for clinical use.
Currently, there is no licensed medicine or
vaccine for Ebola virus disease, but several
products are under development

154. Mapp Biopharmaceutical’s ZMapp
 An experimental treatment is a combination
or cocktail of three monoclonal antibodies
that is designed to bind to the protein of the
Ebola virus, neutralizing the virus so it can’t
do any further damage.

155. WHO’s travel advice
The risk of Ebola infection for travellers is very
low since person‐to‐person transmission results
from direct contact with the body fluids or
secretions of an infected patient.
WHO does not recommend any travel or trade
restrictions be applied except in cases where
individuals have been confirmed or are
suspected of being infected with EVD or where
individuals have had contact with cases of EVD.

156. The risk of a tourist or businessman/woman
becoming infected with Ebola virus during a visit
to the affected areas and developing disease
after returning is extremely low.
Transmission requires direct contact with blood,
secretions, organs or other body fluids of
infected living or dead persons or animal, all of
which are unlikely exposures for the average
traveller. In any event, tourists are advised to
avoid all such contacts.

159. Transmission to health-care
workers has been reported
when appropriate infection
control measures have not
been observed.

160. It is not always possible to identify patients
with EBV early because initial symptoms may
be non-specific.
It is important that health-care workers apply
standard precautions consistently with all
patients – regardless of their diagnosis – in all
work practices at all times.

162. Close physical contact with
Ebola patients should be
avoided.

163. Personal protective equipment should be worn
when taking care of ill patients .
 PPE should include at least:
i. Gloves,
ii. Impermeable gown,
iii. Boots/closed shoes with
overshoes
iv. Mask
v. Goggles or face shields.

168. Other key precautions are safe injection and
phlebotomy procedures, including safe
management of sharps, regular and rigorous
environmental cleaning, decontamination of
surfaces and equipment, and management of
soiled linen and of waste.
In addition, it is important to ensure safe
processing of laboratory samples from
suspected or confirmed patients with EDV

170.  Isolating patients with suspected or confirmed
Ebola virus disease in single isolation rooms is
recommended.
 Where isolation rooms are not available, it is
important to assign designated areas, separate
from other patients, for suspected and confirmed
cases.
 In these designated areas, suspect and confirmed
cases should also be separate
 Access to these areas should be restricted

171. Stopping visitor access to patients infected
with EVD is preferred.
If this is not possible, access should be
given only to those individuals who are
necessary for the patient’s well‐being and
care, such as a child’s parent

172. People who have died from Ebola should
only be handled using appropriate protective
equipment and should be buried immediately
by public health professionals who are
trained in safe burial procedures.
it's important to avoid direct contact with the
body of an Ebola victim who has died

173. Liberian health workers on the way to
bury a woman who died of the Ebola
virus

175. For healthcare workers in Africa, who are most
likely to encounter cases of Ebola, prevention
focuses on being able to recognize cases of the
disease when they appear, as well as using
barrier isolation techniques to avoid direct
contact with infected people.
 improved hospital infection control crucial

186. Egypt is Ebola free, but not far
from the outbreak

187. Clinicians caring for travellers returning from
affected areas with compatible symptoms are
advised to consider the possibility of
Ebola virus disease.

189. Panic is our enemy
Knowledge is our
friend
Preparation is our best
line of defence