EBOLA VIRUS

• Appeared in 1976
• 5 distinct species -Bundibugyo, Zaire, Reston, Sudan, Tai Forest
• Named after Ebola river where disease first appeared
• Reston species mild and found in Phillipines and China, non fatal
• Other species in Africa
• Shaped like a Sheperd's crook, coiled or branched

TRANSMISSION OF VIRUS

• Close contact with blood, secretions, organs and other body fluids of infected animals or humans(Chimpanzees, gorillas, bats, monkeys, antelopes-ill or dead in rainforests)
• Burial ceremonies where mourners have direct contact with body of deceased
• Men who have recovered from the disease can transmit virus through semen for up to 7 weeks
• It is not airborne

SIGNS AND SYMPTOMS

• Fever
• Intense weakness , muscle pain
• Headache
• Sore throat
• Vomiting, diarrhea
• Rash
• Impaired liver and kidney function
• Internal and external bleeding
• Low TLC and low platelet count

INCUBATION PERIOD: 2-21 days

DIAGNOSIS

• EXCLUDE other diseases including malaria, typhoid, cholera, leptospirosis, rickettsiosis, meningitis, hepatitis, viral hemorrhagic fever including dengue
• Several tests are available for ebola including ELISA, Antigen detection tests, RT-PCR, electron microscopy, virus isolation by cell culture
• These tests cannot be carried out in routine labs as samples from these patients are extreme biohazard and tests are conducted under maximum biological containment in specialised labs only.

VACCINE AND TREATMENT

• No vaccine
• Trials on and first batch of vaccines expected by 2015
• No specific treatment available. Patient needs hydration and severely ill need ICU supportive care
• New drugs being evaluated. ZMapp , an experimental drug used in US healthcare workers amidst controversy as not yet adequately tested or approved by FDA

PREVENTION AND CONTROL

• Active animal health surveillance system to detect new cases and warn human public health authorities
• In humans, reducing risk of wildlife to human transmission from infected bats or monkeys
• Adequately cooked meats are not a source of infection
• Human to human transmission reduced by avoiding direct or close contact with infected patients particularly their body fluids
• Gloves and appropriate protective clothing
• Transmission to healthcare workers has been observed when appropriate infection control measures have not been observed. it is not always possible to identify patients with ebola early because initial symptoms maybe nonspecific. So healthcare workers will have to use standard precautions with all patients irrespective of diagnosis and at all times
• When in close contact within 1 metre of patients, healthcare workers should wear face shield or a face mask with goggles, a clean non sterile long sleeved gown and gloves
• Hand hygiene
• Quarantine/enforced isolation
• Burial and rituals like embalming discouraged

MORBIDITY AND MORTALITY

• Two American aid workers infected with ebola in west Africa were treated in a hospital in Atlanta in a containment unit. A Spanish priest died from ebola after return from Africa
• This outbreak has caused more mortality than any of the previous outbreaks since 1976
• Two leading doctors-Dr Cole and Dr Sheik Humarr Khan succumbed to the current epidemic in Sierra Leone.

Dr Monica MAHAJAN
Lead Consultant Internal Medicine Max Healthcare