Ebola Virus Disease Clinical manifestations Ebola Virus Disease Clinical manifestations N. Shindo Lead, Clinical & Infection Control Pandemic & Epidemic Diseases Department

2 |2 | Ebola virus disease outbreak in 2014 Caused by Zaire ebolavirus WHO clinicians have been working in all three countries with national and international partners Data are based on two journal publications to which WHO clinical network contributed: –Clinical presentation of patients with Ebola Virus Disease in Conakry, Guinea. NEJM, 2014 –Clinical illness and outcomes in patients with Ebola in Sierra Leone. NEJM, 2014

3 |3 | Common features Guinea case series (N=37) Sierra Leone Case series (N=44)* Fever31/37 (84%)89% Fatigue24/27 (65%) 66% (weakness) Headache12/21 (57%)80% Diarrhoea23/37 (62%)51% Vomiting21/36 (57%)34% * At the time of presentation

4 |4 | Other symptoms Abdominal pain 40% (SL) Sore throat 34% (SL) Conjunctivitis 31% (SL) Tachycardia 62% (Guinea) Hiccups 28% (Guinea) Skin rush ( patients in Europe and USA)

5 |5 | Fatigue or weakness, Fever, headache, sore throat Non-specific, differential diagnosis difficult –Malaria –Influenza-like Illness –Lassa fever –Typhoid fever Initial symptoms of EVD

6 |6 | EVD Disease clinical course (fatal patients) Prodrome? Onset GI symptoms Shock, multiorgan failure Hemorragic symptoms death Incubation period (2-21 days) SL: 6-12 days Case fatality rate: 74% (SL), 43% (Guinea) 4-5 days 8 (7-11) days (SL) 4-5 days

7 |7 | Other points Older age group more likely to have severe outcomes including death (40 years or older, 3.5 times more, Guinea) Severe dehydration, hypovolemic shock and electrolytes/metabolic abnormalities lead to multiorgan failure and death Some CNS symptoms: confusion, delirium, convulsions Case fatality rate differs from one place to the other Ebola haemorrhagic fever vs Ebola virus disease –Seen in about a half of fatal patients (Guinea) –Late complication in severe illness

8 |8 | Challenges Frontline healthcare workers are at risk of being exposed to dangerous pathogens and also can become sources of healthcare associated infection, Too busy and occupied to manage patients and no time or resource for data collection, Have limited information due to lack of resources for case management and treatment.

9 |9 | Needs for means to play the role Efficient case detection – Triage System in place for reporting Good & safe biological sample collection for laboratory testing – Sampling (Which? How?) and better access with capable laboratories Better treatment – syndromic approach, evidence based  Motivation Protect self, colleagues, patients and environment

10 | Clinical network activities Deployment of ID physician and Intensive/critical care specialists to support clinicians at EVD treatment centres VHF case management 'Pocket Book' based on IMAI approach both in English and French

11 | Ebola Virus Disease Outbreak in West Africa 2014 LET'S UNITE AND HELP JOIN US!!!