1. Viral Haemorrhagic Fever: The West African Zaire Ebola Virus outbreak
Dr Eleri Wilson-Davies
Consultant Medical Virologist
West of Scotland Specialist Virology Centre

2. VHF are of particular public health importance because they:
Can spread readily within a hospital setting
Have a high case-fatality rate
Are difficult to recognise and detect rapidly
There is no evidence based treatment

4. 1976
Yambuku, Democratic Republic of Congo (previously Zaire) – near Ebola river
Nzara, Sudan
318 cases
280 deaths
38 serologically confirmed survivors
88% mortality rate
Serum specimens were collected from persons in villages in the epidemic area if they had acute febrile illness during the epidemic period and were in contact with probable cases

5. Family: Filoviridae
Species:
Zaire ebolavirus (EBOV)
Sudan ebolavirus (SUDV)
Bundibugyo ebolavirus (BDBV)
Taï Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)

6. Helical polymorphic
Non-segmented
Negative sense
Single-stranded RNA viruses
Variable lengths

7. Primary transmission
Contact with the blood, secretions, organs or other bodily fluids of infected animals
Fruit bats
Chimpanzees
Gorillas
Monkeys
Forest antelope
Porcupines

8. Secondary transmission
NO AEROSOL TRANSMISSION
Mucous membrane protection prevents ALL transmission
All VHFs enveloped viruses
Easily inactivated
In the UK the greatest risk to health care staff occurs BEFORE the diagnosis

9. West Africa Outbreak 17/11/14
CASES DEATHS
Spain 1
Guinea
Sierra Leone
Senegal 1
Mali
Liberia
Nigeria
United States
TOTAL 14,413 5,177
CURRENT REPORTED MORTALITY 36%

10. Why? Poverty Travel for work Civil war Lack health infrastructure
Doctors 1-2 per 100,000 of population in urban areas
No/insufficient PPE
HCW fail to be paid

11. Culture Fear Hide symptomatic family members
Long-standing funeral practices that involve close contact with highly infectious corpses
Distrust of government - corruption
Two Nigerians have died after drinking salt water, which was rumoured to be protective

17. APPENDIX 7: LABORATORY PROCEDURES

18. Publications: BBV laboratory infections
Most recent references are from
These are not representative of current health and safety practice
Grist NR, Emslie JAN. Infections in British clinical laboratories, 1988–1989. J Clin Pathol 1991; 44:667–9. Extract from the abstract:
"Hepatitis was not reported. The sustained low level of hepatitis is encouraging and suggests a low risk to staff of bloodborne infections such as human immunodeficiency virus."

19. Walker D, Campbell D. A survey of infections in United Kingdom laboratories, 1994–1995. J Clin Pathol 1999; 52:415–8. The single bloodborne virus infection reported (HCV) details in table 6, the possible laboratory infection was potentially acquired by an ancillary staff member who 'may have' cut themselves on glass, as they worked in the wash up area.

20. Take home message:
If you protect yourself from blood-borne viruses (HIV/HBV/HCV) you are protecting yourself against VHF viruses

21. www.hps.scot.nhs.uk Dr Eleri Wilson-Davies eleridavies@nhs.net
Consultant Medical Virologist
West of Scotland Specialist Virology Centre