NotesEbola

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yasmin yousif
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University: Khartoum University
Degree (College): MBBS
Graduation Year: 2007
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Speciality: General Medicine
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Ebola

Unread post by yasmin yousif » 25 Dec 2014, 16:08

 Ebola Virus Disease
 (Ebola hemorrhagic fever)
 EPIDEMIOLOGY
 It is a severe, often fatal, illness
 It affects humans and nonhuman primates.
(e.g. fruit bats, monkeys and apes)
 Death rate is up to 90%
 First appeared in 1976 in two simultaneous outbreaks:
1. Congo (near Ebola river)
2. Sudan (in remote area)
 Third outbreak occurred in the Philippines from
infected imported monkeys, in 1989.
 Fourth outbreak is going in west Africa.
It started in Guinea, in March 2014 and has
spread to Liberia, Sierra Leone and Nigeria.
 What is the causative organism?
 Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus.
 Genus Ebolavirus comprises 5 distinct species:
1. Bundibugyo ebolavirus (BDBV)
2. Zaire ebolavirus (EBOV)
3. Reston ebolavirus (RESTV)
4. Sudan ebolavirus (SUDV)
5.Taï Forest ebolavirus (TAFV).

`
Ebola is a filamentous,
single-stranded RNA virus
 How DOES INFECTIO START?
 First infection occurs by Contact with blood, secretions and other body fluids of infected/dead animals
 High risk animals are:
1. Fruit bats
2. Monkeys
3. Apes
 Once a person comes in contact with infected
animal, it can spread within the community
from human to human
 HOW DO PEOPLE BECOME INFECTED?
 Infected persons/dead bodies are the sources of infection
 Direct contact with
*Blood
* Secretions (stools, urine, saliva and semen)
* Body fluids
or contaminated items (clothes, linen, needles)
Route of entry through:
1. Non-intact skin
2. Mucous membrane
 So infection spreads through:
1. Unsafe case management
2. Unsafe burial practices
 Infectivity period
 Incubation period: 2-21 days
 Infectivity begins with start of symptoms
(not during IP)
 Patients are infectious as long as they
contain the virus in their blood and sections
 Infected patients should be monitored clinically and by lab investigations, to determine that they are no more infectious to others, before they return home
 Men recovered from illness can still spread
the virus to their partners, through semen up to
7 weeks after recovery (sexual intercourse is
prohibited through this period).
 Who is at risk of infection?
 HCWs
 Family members or others in close contact with
infected persons
 Hunters in the rain forest who come on contact
with dead animals
 Mourners who have direct contact with deceased bodies (as part of burial ceremonies)
More studies are needed to understand if some
groups are more susceptible than others to
Contacting the virus:
 Immunocopromised
 People with underlying conditions/diseases
 What are the typical signs an symptoms?
Typical symptms
 Sudden onset of fever
 Intensive weakness
 Muscle pains
 Headache
 Sore throat
Followed by:
 Vomiting
 Diarrhea
 Rash
 Impaired kidney and liver functions
In some cases:
 Bleeding (internal and external)
Lab findings (confirmatory diagnosis):
 Decreased WBCs
 Decreased platelets
 Increased liver enzymes
 Antibody-capture enzyme-linked immunosorbent assay (ELISA)
 Antigen detection tests
 Serum neutralization testreverse transcriptase polymerase chain reaction (RT-PCR) assay
 Virus isolation by cell culture
 When should a person seek for
medical care?
Any person who:
 Has been in an area known to have the disease
 In contact with a person known or suspected
to have the disease
And , begins to have symptoms
should seek prompt medical care
 What is the tratment?
NO SPECIFIC TRATMENT
NO VACCINE
Both are experimental
 Isolation precautions
 Strict Infection control practices
 Intensive supportive care (e.g. IVF, as patients are dehydrated).
SOME PATIENTS WILL RECOVER
WIT APPROPRIATE MEDICAL CARE
 HOW CAN WE PREVENT SPREAD OF INFECTION?
IN COMMUNITY:
 Orientation for people about the nature of
disease and transmission ways
 Encouraging them to do hand hygiene when
visiting patients in hospitals or caring someone
at home
IN HOSPITALS
 Standard precautions
 Isolation precautions
 Hand hygiene
 Use of PPE:
1. Gowns
2. Gloves
3. Medical mask
4. Face covers (face shield / goggles)
 Invasive procedures (high risk of exposure):
Strict procedure, with complete barriers
 Patients died from infection should be handled
using appropriate PPE and buried immediately
 WHAT IS WHO’S TRAVEL ADVICE DURING
OUTBREAKS?
Risk of infection for travelers is very low
Since transmission occurs by direct contact with blood, secretions or body fluids of infected persons.
 Travel restrictions if necessary
 Avoid any contact with infected patients
 Travelers returning from affected areas should be aware of symptoms and seek medical advice
at first sign of illness
 MOH GUIDELINES
 Strict contact isolation precautions and using
proper PPE (Gloves, gown, mask and face covering)
 Hand hygiene is essential
 Dedicated medical equipment (preferably disposable), should be used of patient care
 All non-dedicated, non-disposable equipment
should be disinfected in between patients
 Procedures and lab testing should be limited to
the minimum necessary for essential diagnosis
and medical care
 All needles and sharps should be handled with
extreme care and disposed immediately after use
 MOH GUIDELINES (CONTINUED)
 Environmental cleaning and disinfection safe
1. Use of the hospital environmental disinfectant is
enough
2. Handling of potentially contaminated
materials is highly important.
Housekeepers should use additional barriers
as shoe and leg coverings
3. Face protection by PPE should be used when
there is probability of splashing during waste
disposal

 MOH GUIDELINES (Continued)
 AEROSOL-GENARATION PROCEDURS
1. Conducted under airborne isolation
precautions
2. Using same PPE (as we do with MERS-CoV)
added to disposable shoe cover
3. Limiting the number of HCWs present during
the procedure to the essential needed
 MOH GUIDELINES (CONTINUED)
 Management of potentially exposed HCWs
1. Apply procedure of occupational exposure to
blood borne infection (needle prick or splashing
of blood or blood soiled secretions to the mucous
membrane of eyes, mouth or nose)
2. HCWs should receive follow up care for 21 days.\,
including fever checking twice daily.
3. Exposed HCW may continue work, while being
monitored.
 MOH GUIDELINES (CONTINUED)
 Visitors education
1. Visitors are not allowed to enter patient's room,
except for exceptional conditions that are essential
for patient’s wellbeing
2. Visitors should be screened for Ebola virus once they
arrive to the hospital
3. Visitors movement should be restricted to patient
care area
4. Visitors should be instructed about the natutre of
the disease

 To summarize
1. Ebola virus disease is a severe, often fatal, illness
2. Death rate is up to 90%
3. Infection starts from contact with infected animals
then spreads from human to human.
4. Infected persons and dead bodies are the source of
infection
5. Infection occurs by direct contact with:
*Blood
*Secretions (stools, urine, saliva and semen)
*Body fluids
6. IP is 2-21 days and infectivity period begins
with start of symptoms (not during IP)
7. The patient becomes no more infectious based
on clinical and lab investigations
8. Typical symptms
 Sudden onset of fever
 Intensive weakness
 Muscle pains
 Headache
 Sore throat


9. Followed by:
 Vomiting
 Diarrhea
 Rash
 Impaired kidney and liver functions
In some cases:
 Bleeding (internal and external)
10. Confirmation (by lab investigations)
 Deceased WBCs and platelets
 Increased liver enzymes
 Detecting the virus:
*Ag
*Ab
*PCR
*Culture
11. There is no specific treatment or vaccine
(experimental)
12. Prevention and conservative measures:
*Isolation precautions and use of PPE
*Strict infection control practices
* Intensive supportive care
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