2. Who am i? A 'Merciless' Virus

3. EBOLA The Deadly African Virus Dr.S.Nizamudeen

4. EBOV is also considered to have potential as a biological weapon and is categorized as a EBOV is also considered to have potential as a biological weapon and is categorized as a “Category A” bioterrorism “Category A” bioterrorism agent by the Centers for agent by the Centers for Disease Control Prevention Disease Control Prevention IS IT JUST A VIRUS ?

5. Ebola Virus Introduction First appeared in Africa 1976 “African Hemorrhagic Fever” –Aute,mostly fatal disease –Aauses blood vessel “bursting” –Systemic (all organs/tissues) –Humans and nonhuman primates 2,127 cases including 1,145 deaths has been reported

7. Ebola Taxonomy Scientific Classification Order : Mononegavirales Family : Filoviridae Genus : Ebola like viruses Species : Ebola Subtypes* –Ebola- Zaire, Ebola-Sudan,Ebola- Ivory Coast »disease in humans –Ebola-Reston »disease in nonhuman primates Copyrighted Dr. Fre:derick A. Murphy, D.V.M., Ph.D. 1976. Image courtesy of the Centers for Disease Control * 2012 virus taxonomy of the International Committee on Taxonomy of Viruses * 2012 virus taxonomy of the International Committee on Taxonomy of Viruses,

8. Filoviridae or “Filoviruses” Most mysterious virus group Pathogenesis poorly understood Ebola –natural history/reservoirs unknown –exist throughout the world –endemic to Africa –filamentous ssRNA - (antisense) viruses Image courtesy of the Centers for Disease Control

9. Morphology “No virus is known to be good. It has been well said that a virus is piece of bad news wrapped up in proteins”

10. Morphology under electron microscope Filamentous, enveloped RNA virus Approx. 19 kb in length (1 kb = 1000 RNA bases/nucleotides) or 60-80 nm in diameter Single-stranded, linear, non- segmented Negative-sense RNA (encoded in a 3’ to 5’ direction) Appears to have “spikes” due to glycoprotein on outside membrane

11. Structure of Ebola genome and proteins –Transcribed into 8 sub-genomic mRNA proteins: 7 structural and 1 nonstructural –7 structural proteins: Nucleoprotein (NP) 4 viral/virion proteins (VP35, VP40, VP30, VP24) Glycoprotein (GP) RNA-dependent RNA polymerase (L protein) –NP, VP35, VP30, L protein: required for transcription & replication –VP40, GP, VP24: associated with the membrane

14. Ebola Pathogenesis Copyright: Russell Kightley Media, Australia Ebola Skin,MM,CM Viral RNA Released in to cytoplasm Replication & production of new viral proteins Coated With proteins Formation of cores Multiple no of RNA Ebola virus

15. Onset of illness : Abrupt Incubation period :2 to 21 days Infections are acute and mostly deadly TRANSMISSION Direct contact blood /secretions of infected person Exposure to contaminated objects such as Needles Etc EBOLA EPIDEMIOLOGYEBOLA EPIDEMIOLOGY

17. FOR INFO CALL 101

18. Diagnostic Tests Early Diagnosis Early Diagnosis »very difficult »signs & symptoms very similar to other infections Laboratory Test Laboratory Test »PCR detection »ELISA (enzyme-linked immuno- absorbant) assay

19. Ebola : Hunt On to Treat, Prevent the 'Merciless' Virus No Standard Treatment available No Standard Treatment available Patients receive supportive therapy Patients receive supportive therapy »treating complicating infections »balancing patient’s fluids and electrolytes »maintaining oxygen status and blood pressure

20. Prevention No vaccines! Patients are isolated (QUARANTINE) Medical Staff Training –western sanitation practices »intake »care during stay »after patient dies Infection-control Measures –complete equipment and area sterilization

21. Prevention After Death Virus contagious in fluids for days Burial use extreme caution –handling and transport –cultural practices/ religious belief –incinerate all waste !!!!

22. Latest Morbidity and Mortality Reports Ebola-Reston Virus Infection Among Quarantined Nonhuman Primates -- Texas, 1996 Ebola-Reston Virus Infection Among Quarantined Nonhuman Primates -- Texas, 1996 –report describes death and blood testing of cynomolgus monkey imported from the Philippines held in a private quarantine facility in Texas Outbreak of Ebola Hemorrhagic Fever ---Uganda, August 2000--January 2001 Outbreak of Ebola Hemorrhagic Fever ---Uganda, August 2000--January 2001 –report describes surveillance and control activities related to the EHF outbreak –presents preliminary clinical and epidemiologic findings

23. Current Basic Research The assembly of Ebola virus nucleocapsid requires virion- associated proteins 35 and 24 and posttranslational modification of nucleoprotein The assembly of Ebola virus nucleocapsid requires virion- associated proteins 35 and 24 and posttranslational modification of nucleoprotein Report describes distinct VP35 and VP24 proteins mechanism of regulation for filovirus assemblyReport describes distinct VP35 and VP24 proteins mechanism of regulation for filovirus assembly suggests new approaches for viral therapies and vaccines for Ebola and related virusessuggests new approaches for viral therapies and vaccines for Ebola and related viruses Detection of antibodies against the four subtypes of Ebola virus in sera from any species using a novel antibody-phage indicator assay Detection of antibodies against the four subtypes of Ebola virus in sera from any species using a novel antibody-phage indicator assay »assesses the presence of specific antibodies in serum »describes development of a novel assay for the detection of seroconversion irrespective of Ebola virus subtype or animal species

24. A CMV-based vaccine confers protection against ebola virus in mice. A CMV-based vaccine confers protection against ebola virus in mice. Another vaccine appears to be well tolerated in rhesus macaquesimmunocompro mised by virtue of infection with simian- human immunodeficiency virus and also confers some protection. Another vaccine appears to be well tolerated in rhesus macaquesimmunocompro mised by virtue of infection with simian- human immunodeficiency virus and also confers some protection. Current Basic Research

25. Current Basic Research- Drug Developers ZMAPP- is a cocktail of three so-called monoclonal antibodies, which are derived from living cells and are designed to bind to and neutralize the Ebola virus. ZMAPP- is a cocktail of three so-called monoclonal antibodies, which are derived from living cells and are designed to bind to and neutralize the Ebola virus. –This product of Reynolds american m anufactures has shown promise in monkey studies, but the drug's safety hasn't been established in human clinical trials. Reynolds american Reynolds american –Mapp last week said it was working with government agencies to increase production of the drug and with WHO for ethical trails in human.

26. TKM-Ebola, which is a Ribonucleic acid interference to combat the virus. TKM-Ebola, which is a Ribonucleic acid interference to combat the virus. –Developed by Canada's Tekmira Pharmaceuticals Corp Tekmira PharmaceuticalsTekmira Pharmaceuticals Current Basic Research- Drug Developers

27. References Reemergence of Ebola Virus in Africa; Anthony Sanchez et al,EID Volume 1 * Number 3 July-September 1995 Reemergence of Ebola Virus in Africa; Anthony Sanchez et al,EID Volume 1 * Number 3 July-September 1995 http://www.cdc.gov/ncidod/EID/vol1no3/sanchez.htm Viral Hemorrhagic Fever, Healthlink, Medical College of Wisconsin, 2000 Viral Hemorrhagic Fever, Healthlink, Medical College of Wisconsin, 2000 http://healthlink.mcw.edu/article/955159073.html http://healthlink.mcw.edu/article/955159073.htmlhttp://healthlink.mcw.edu/article/955159073.html Isolation and Phylogenetic Characterization of Ebola Viruses Causing Different Outbreaks in Gabon Isolation and Phylogenetic Characterization of Ebola Viruses Causing Different Outbreaks in Gabon Emerging Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention,February 5, 1997 http://www.cdc.gov/ncidod/EID/vol3no1/courbot2.htm http://www.cdc.gov/ncidod/EID/vol3no1/courbot2.htmhttp://www.cdc.gov/ncidod/EID/vol3no1/courbot2.htm Hemorrhagic fevers; Julia Barrett, Gale Encyclopedia of Medicine, Gale Research, 1999 Hemorrhagic fevers; Julia Barrett, Gale Encyclopedia of Medicine, Gale Research, 1999 http://www.findarticles.com/cf_dls/g2601/0006/2601000652/p1/article.jhtm http://www.findarticles.com/cf_dls/g2601/0006/2601000652/p1/article.jhtmhttp://www.findarticles.com/cf_dls/g2601/0006/2601000652/p1/article.jhtm l Key Issues in the Prevention and Control of Viral Hemorrhagic Fevers Clarence J.Peters, MD, Special Pathogens Branch/Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases/Centers for Disease Control and Prevention, 1997 http://www.cdc.gov/od/ohs/sympsium/symp43.htm http://www.cdc.gov/od/ohs/sympsium/symp43.htmhttp://www.cdc.gov/od/ohs/sympsium/symp43.htm Scientific Stock Images Library; Russell Kightley Media,Australia Scientific Stock Images Library; Russell Kightley Media,Australia http://www.rkm.com.au/imagelibrary/index.html http://www.rkm.com.au/imagelibrary/index.htmlhttp://www.rkm.com.au/imagelibrary/index.html Outbreak of Ebola Hemorrhagic Fever ---Uganda, August 2000--January 2001, Outbreak of Ebola Hemorrhagic Fever ---Uganda, August 2000--January 2001, Morbidity and Mortality Weekly Report, Vol 50, No 05;73, 02/09/2001 / 50(05);73-7 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005a1.htm Ebola-Reston Virus Infection Among Quarantined Nonhuman Primates -- Texas, 1996 Ebola-Reston Virus Infection Among Quarantined Nonhuman Primates -- Texas, 1996 Morbidity and Mortality Weekly Report, Vol 45, No 15;314,April 19, 1996 / 45(15);314-316 Morbidity and Mortality Weekly Report, Vol 45, No 15;314,April 19, 1996 / 45(15);314-316 http://www.cdc.gov/mmwr/preview/mmwrhtml/00040920.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/00040920.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/00040920.htm The assembly of Ebola virus nucleocapsid requires virion-associated proteins 35 and 24 and posttranslational modification of nucleoprotein, Huang Y et al, Mol Cell. 2002 Aug;10(2):307-16. PMID: 12191476 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12191476&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12191476&dopt=Abstract Detection of antibodies against the four subtypes of ebola virus in sera from any species using a novel antibody-phage indicator assay.; Meissner F et al, PMID: 1235035 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12350354&dopt=Abstract. Outbreak of Ebola Hemorrhagic Fever updated Aug 2014 http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/47241 http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/47241

28. Thank you for your kind attention ! Qestions ? Lets Pray