DISASTER A total of 2,615 Ebola infections and 1,427 deaths highest case fatality rates of any human virus, 88%

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2 DISASTER A total of 2,615 Ebola infections and 1,427 deaths highest case fatality rates of any human virus, 88% ETYMOLOGY First recorded outbreak at,yambuku in democratic republic of congo (EBOLA RIVER) VIRUS ( Latin virulentus) Viruses do not contain enzymes for energy production or protein synthesis. small infectious agent that replicates only inside the living cells of other organisms

3 STROKES YEAR REGIONS AFFECTED DISCRIPTION FIRST 1976 Democratic republic of congo (ZAIRE) & sudan First outbreak of Ebola. Hemorrhagic fever SECOND 1989 Reston,Virginia mysterious outbreak. (initially diagnosed as Simian hemorrhagic fever virus (SHFV)) among a shipment of crabeating macaque monkeys imported from the Philippines. named Reston ebolavirus (REBOV) THIRD 2014 WEST AFRICA -affecting Guinea, Sierra Leone, Liberia and Nigeria. largest outbreak to the date

4 Ebola Taxonomy Group Order Family Genus : Group V (-)sense RNA : Mononegavirales : Filoviridae : Ebolavirus Species Bundibugyo (BDBV) Sudan (SUDV) Tai forest (TAFV) Formerly Cote d-ivoire Zaire ebola (EBOV) The most dangerous Reston (RESTV) Non-humans

in diameter Negative-sense enveloped RNA (3 to 5 direction) Spikes

5 STRUCTURE Single-stranded, linear, non-segmented Filamentous - shape of U or 6 Coiled, toroid, or branched 19 kb length,60-80 nm in diameter Negative-sense enveloped RNA (3 to 5 direction) Spikes appearance 8 sub-genomic mrna proteins: 7 structural and 1 nonstructural

6 Ebola Pathogenesis ebola Attach to walls Leakage of blood and serum into surrounding tissue Wbcs attack Wbcs dissolve Entire body leaks and dissolves Permanent bleeding Blood vessels more damaged Proinflammatory cytokines Pro coagulants Also released Chemical released

7 Enters Bloodstream skin, membranes,open wounds Cell Level docks with cell membrane Viral RN released into cytoplasm production new viral proteins New viral genomes rapidly coated in protein create cores =srv19gkz4e0 Viral cores stack up in cell migrate to the cell surface Produce trans-membrane proteins Push through cell surface Become enveloped by cel membrane ssrna - Genome Mutations Capable of rapid mutation very adaptable to evade host defenses and environmental change

8 Transmission Environment to Human : Fruit bats-natural reservoir Gorilla, chimpanzee, monkey, porcupine, duiker Human to human : 1. Direct contact 2. Contaminated medical equipment 3. Traditional burial rituals 4. Medical workers 5. Survivors(via semen for 2 months)

9 SIGNS AND SYMPTOMS 1 Early symptoms : Influenza(fatigue,fever,headache,joint & abdominal pain) Vomiting,diarrhea Loss of appetite Sore throat,chest pain,hiccups,shortness of breath, trouble swallowing Weakness Maculopular rash(50% cases) Myalgia(muscular pain or tenderness),back pain Mucosal redness of the oral cavity

10 SIGNS AND SYMPTOMS 2 Acute symptoms : Bleeding from puncture sites and mucous membrane(eg.nose,gums and gastrointestinal tract) Internal and subcutaneous bleeding anuria(absence of urine formation) raddening of eyes,bloody vomit Impaired blood clotting Multiple organ dysfunction syndrome which leads to death

12 EFFECT OF EBOLA THE PATIENTS WILL HAVE DIARRHEA PHARYNGITIS. THE INFLAMMATION OF THE THROAT AND EYE. CAUSES SEVERE DAMAGE TO THE SKIN. ATTACKS EVERY TISSUE AND ORGAN OF THE BODY EXCEPT THE SKELETAL MUSCLES AND BONES. CAN ATTACK THE CONNECTIVE TISSUES THAT ARE RAPIDLY MULTIPLYING IN COLLAGEN. CAUSES SMALL BLOOD CLOTS TO FORM IN THE BLOODSTREAM OF THE PATIENT AND FORMS RED SPOT ON THE SKIN SPONTANEOUS BLEEDING THEN OCCURS FROM BODY ORIFICES AND GAPS IN THE SKIN

skin contains Rash over the entire body that often blood Roof of

13 EHF & EVD EHF ( EBOLA HEMORRHAGIC FEVER ) : Internal and External Bleeding occurs Genital swelling Increased feeling of pain in the skin contains Rash over the entire body that often blood Roof of mouth looks red EVD ( EBOLA VIRUS DISEASE ) : Bleeding does not occur

14 EBOLA IN NON-HUMAN PRIMATES NON-HUMAN PRIMATES HAVE BEEN A SOURCE OF INFECTION FOR HUMANS EBOLA OUTBREAKS FROM THE EBOV AND TAFV SPECIES HAVE BEEN OBSERVED IN CHIMPANZEES AND GORILLAS. RESTV HAS CAUSED SEVERE EVD OUTBREAKS IN MACAQUE MONKEYS (MACACA FASCICULARIS). RESTV VIRUSES HAVE BEEN DETECTED DURING SEVERAL OUTBREAKS OF A DEADLY DISEASE IN PIGS IN PEOPLE S REPUBLIC OF CHINA AND PHILIPPINES.

15 CHRONOLOGY OF EBOLA VIRUS DISEASE OUTBREAKS COUNTRY DRC, UGANDA DRC, UGANDA YEAR EBOLAV IRUS SPEICE S 2012 BUNDIBU GYO,SUD AN 2007 BUNDIBU GYO,ZAI RE CAS ES DEATH CASE FATALI TY % % UGANDA 2000 SUDAN % DRC 1995 ZAIRE % COTE 1994 TAI % D`LOVIRE, FOREST, : DRC- DEMOCRATIC REPUBLIC OF GOBANA ZAIRE CONGO SUDAN 1979 SUDAN %

16 TABLE EBOLA OUTBREAKS,2014 (BY WHO) 1. DRC 2. GUINEA 3. LIBERIA 4. NIGERIA 5. SIERRA LEONE DRC= democratic republic of congo 24 CASES,13 DEATHS. 607 CASES,406 DEATHS CASES,624 DEATHS. 16 CASES, 5 DEATHS. 910 CASES, 392 DEATHS.

17 Anti-Fluenza:Avigan ZMapp (JAPAN) combination of antibodies (inactivate ebola virus) is effective in primates, studies in humans yet to be done(effectively treat 43% of animals challenged with the Ebola virus) WHO has given an ethical green light to the use of these experimental therapies (testing on 2 nd august) would provide a medical tool to discourage the use of Ebola virus as an agent of bioterrorism

18 PREVENTION OF EBOLA Avoid contact with other infected humans, animals or objects Raising awareness by IEC &BCC Reducing human to human transmission by use of PPE Safe disposal of the dead Active surveillance Contact tracing & monitoring Reporting /Notification

19 PRECAUTIONS Use Standard Precautions Routine Hand washing Handle and Dispose of Instruments Safely Cook meat thoroughly Environment Cleaning

20 FIVE TYPES OF HAND HYGEINE

Gather Recommended Supplies Bed and mattress, Plastic sheeting, One thermometer, Covered container, Screens or other barriers Plan Disinfection for VHF-Contaminated

21 Gather Recommended Supplies Bed and mattress, Plastic sheeting, One thermometer, Covered container, Screens or other barriers Plan Disinfection for VHF-Contaminated items using 1)Ordinary Household Bleach 2)Soap and Clean Water 3)Sterilization Set Up Changing Rooms for patient-care staff Place Security Barrier Around Isolation Area

22 TREATMENT No specific treatment available but experimental ones are Frequent dehydration and oral rehydration with solutions containing electrolytes or intravenous fluids. Maintaining oxygen status and blood pressure Replacing lost blood Treating other infections if they occur Timely treatment of ebola is difficult due to difficult diagnosis

23 VACCINES No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use. Difficulty in making vaccines Obtain to obtain samples and study the disease in remote areas where outbreaks occur. A high degree of biohazard containment is required for laboratory studies and clinical analysis.

24 BIOTERRORISM NATURAL OUTBREAKS OF EBOLA HEMORRHAGIC FEVER IN AFRICA ALARMED GLOBAL HEALTH EXPERTS. RAISES QUESTIONS ABOUT HUMAN ACCESSIBILITY TO THE VIRUS AND HUMAN USAGES OF THE VIRUS FOR HARMFUL PURPOSES. THEN TERRORIST GROUPS COULD USE THE RECENT OUTBREAK OF EBOLA IN AFRICA TO THEIR ADVANTAGE. BY USING THE EBOLA VIRUS AS A BIOLOGICAL WEAPON. THIS PROSPECT IS WORTHY OF CONSIDERATION : 1.DUE TO THE HISTORY OF TERRORIST ATTACKS BY DIFFERENT GROUPS IN THE AREA. 2.THE POTENTIAL FOR THESE GROUPS TO OBTAIN EBOLA IN THE FIELD 3.THE LACK OF POLITICAL CAPACITY IN THE REGION AND GLOBAL WILL TO DEVELOP A VACCINE. 4.THE PATHOGEN S NATURAL OCCURRENCE IN THE REGION. ALTHOUGH DEADLY, EBOLA IS NOTORIOUSLY UNSTABLE WHEN REMOVED FROM A HUMAN OR ANIMAL HOST, MAKING WEAPONIZATION OF THE VIRUS UNLIKELY.

BIOTERRORISM THE POSSIBILITY OF A DELIBERATE OUTBREAK IN EAST AFRICA

VIRUS AS A POWDER, LOAD IT INTO A BOMB, AND THEN EXPLODE THE BOMB IN

IT COULD CAUSE A LARGE NUMBER OF HORRIFIC DEATHS.

25 BIOTERRORISM THE POSSIBILITY OF A DELIBERATE OUTBREAK IN EAST AFRICA IS A GLOBAL HEALTH AND SECURITY ISSUE TERRORISTS COULD HARNESS THE VIRUS AS A POWDER, LOAD IT INTO A BOMB, AND THEN EXPLODE THE BOMB IN A HIGHLY POPULATED AREA. IT COULD CAUSE A LARGE NUMBER OF HORRIFIC DEATHS. - PETER WALSH "THE THING ABOUT EBOLA IS THAT IT'S NOT EASY TO WORK WITH, IT WOULD BE DIFFICULT TO WEAPONIZE. - DR. ROBERT LEGGIADRO

26 CREDIT EN/ WORK/MEDICAL-ISSUES/EBOLA

FREQUENTLY ASKED QUESTIONS ABOUT EBOLA VIRUS DISEASE

FREQUENTLY ASKED QUESTIONS ABOUT EBOLA VIRUS DISEASE What is EBOLA? Ebola, previously known as Ebola hemorrhagic fever, is a deadly disease caused by infection with one of the Ebola virus strains. One