1. The Deadly African Virus
Ebola
The Deadly
African Virus
Davood Yadegarinia
Professor of Infectious Diseases and Tropical Medicine
Research Center, Shahid Beheshti University of Medical Sciences

2. Definition
Ebola virus disease (formerly known as Ebola hemorrhagic fever) is:
A disease caused by the Ebola virus
Is severe- fatality rate 90%
Affects human and non human primates

3. Scientific Classification
Ebola Taxonomy
Scientific Classification
Order: Mononegavirales
Family: Filoviridae
Genus: Ebola like viruses
Species: Ebola
Subtypes -5 types
Ebola-Zaire, Ebola-Sudan,Ebola-Ivory Coast
disease in humans
Ebola-Reston
disease in nonhuman primates

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

5. Ebola hemorrhagic fever
Fatality Rates:
Ebola-Sudan – 60%
Ebola-Zaire – 77-88%
Ebola-Reston – Found in monkeys, has not shown to be fatal in humans
Ebola-Cote D’Ivoire – Only one human case recorded, patient survived
Not much is known about the body’s response because of the dangers of handling samples from infected patients and the short time span available for investigation.
MASS GRAVES FOR EBOLA VICTIMS

6. Filoviridae or “Filoviruses”
Most mysterious virus group
Pathogenesis poorly understood
Ebola
natural history/reservoirs unknown , researchers believe the most likely natural hosts are fruit bats
exist throughout the world
endemic to Africa
filamentous ssRNA- (antisense) viruses
Image courtesy of the Centers for Disease Control
biosafety level 4 agents because of the extreme pathogenicity of certain strains and the lack of a protective vaccine or effective antiviral drug

7. Natural Reservoir Suspected to be a zoonotic (animal-borne)
However, it is unknown what organism carries it naturally without being infected
Suspected vectors
Bats
Primates (in some cases, have been confirmed)
Basically any other animal native to Africa, including mosquitoes, ticks, birds, reptiles

8. History of Ebola virus
Ebola first appeared in 1976 in two simultaneous outbreaks.
- Near the Ebola River in the Democratic Republic of Congo
- A remote area of Sudan.

9. YEAR STROKES FIRST THIRD 1976 SECOND 1989 2014 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 crab-eating 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

10. Case counts as of October 20, 2014
Total Case Count
Laboratory Confirmed Cases
Total Deaths
9216
4218**
4555**
**Numbers are lower than actual laboratory confirmed cases and deaths because stratified data are temporarily unavailable for Liberia.

11. Countries with Widespread Transmission
Case counts as of October 20, 2014
Countries with Widespread Transmission
Cases by Country
Total Case Count
Laboratory Confirmed Cases
Total Deaths
Guinea
1519
1217
862
Liberia
4249 
2484
Sierra Leone
3410
2977
1200
9178
4194*
4546
*Numbers remain unchanged or are lower than actual cases because stratified data are temporarily unavailable for Liberia.

12. Countries with Travel-associated Cases
Case by country
Total case count
Laboratory confirmed cases
Total death
Senegal 1
Spain
Countries with Localized Transmission
Case by country
Total case count
Laboratory confirmed cases
Total death
Nigeria 20 19 8
United states 3 1

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

15. how do people become infected with the virus?
Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. 
In Africa, infection has occurred through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

18. Transmission(cont)
Ebola is extremely infectious but not extremely contagious. It is infectious, because a very small amount can cause illness. Laboratory experiments on nonhuman primates suggest that even a single virus may be enough to trigger a fatal infection.
Instead, Ebola could be considered moderately contagious, because the virus is not transmitted through the air. The most contagious diseases, such as measles or influenza, virus particles are airborne.

19. Ebola Facts about You can’t get E bola through air
You can’t get E bola through water
You can’t get Ebola through food
You can only get Ebola from:
Touching the blood or body fluids of a person who is sick with or has died from Ebola.
Touching contaminated objects, like needles.
Touching infected animals, their blood or other body luids, or their meat.
Ebola poses no signiicant risk to the United States.
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20. Who is most at risk?
During an outbreak, those at higher risk of infection are:
health workers;
family members or others in close contact with infected people;
mourners who have direct contact with the bodies of the deceased as part of burial ceremonies; and
hunters in the rain forest who come into contact with dead animals found lying in the forest. More research is needed to understand if some groups, such as immuno-compromisaed people are more susceptible than others to contracting the virus.

21. EFFECT OF EBOLA the patients will have Diarrhea.
Pharyngitis with 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

22. EHF & EVD EHF ( Ebola Hemorrhagic Fever ) : Bleeding dose not occur
Internal and External Bleeding occurs
Genital swelling
Increased feeling of pain in the skin
Rash over the entire body that often contains blood
Roof of mouth looks red
EVD ( Ebola Virus Disease) :
Bleeding dose not occur

23. Ebola hemorrhagic fever
Target Organs and Damage Methods
Target mainly small capillary vessels. Attach to walls, cause leakage of blood and serum into surrounding tissue.
When white blood cells attack the virus, they dissolve – this releases a chemical into the blood stream that signals the release of other chemicals (pro-inflammatory cytokines, pro-coagulants, and anticoagulants)
These injure blood vessels even worse, resulting in permanent bleeding.
Eventually, the entire body is leaking and dissolving

24. Signs and Symptoms 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

25. Signs and Symptoms 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

27. Diagnosis
Diagnosing Ebola in an person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases, such as malaria and typhoid fever.
However, if a person has the early symptoms of Ebola and has had contact with the blood or body fluids of a person sick with Ebola, contact with objects that have been contaminated with the blood or body fluids of a person sick with Ebola, or contact with infected animals, they should be isolated and public health professionals notified. Samples from the patient can then be collected and tested to confirm infection.

28. Laboratory tests used in diagnosis include:
Timeline of Infection
Diagnostic tests available
Within a few days after symptoms begin
Antigen-capture ELISA testing
IgM ELISA
PCR
Virus isolation
Later in disease course or after recovery
IgM and IgG antibodies
Retrospectively in deceased patients
Immunohistochemistry testing

29. Treatment
No specific vaccine or medicine (e.g., antiviral drug) has been proven to be effective against Ebola.
Symptoms of Ebola are treated as they appear.
The following basic interventions, when used early, can significantly improve the chances of survival:
1-Providing intravenous fluids (IV)and balancing electrolytes (body salts)
2-Maintaining oxygen status and blood pressure
3-Treating other infections if they occur

30. Treatment
Some experimental treatments developed for Ebola have been tested and proven effective in animals but have not yet been tested in randomized trials in humans.
Recovery from Ebola depends on the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer.

31. Prevention There is no FDA-approved vaccine available for Ebola.
If you travel to or are in an area affected by an Ebola outbreak, make sure to do the following:
1-Practice careful hygiene. Avoid contact with blood and body
fluids.
2-Do not handle items that may have come in contact with an
infected person’s blood or body fluids.
3-Avoid funeral or burial rituals that require handling the
body of someone who has died from Ebola.

32. Prevention 4-Avoid contact with bats and nonhuman primates or
blood, fluids, and raw meat prepared from these
animals.
5-Avoid hospitals where Ebola patients are being
treated. The U.S. embassy or consulate is often able
to provide advice on facilities.
6-After you return, monitor your health for 21 days
and seek medical care immediately if you develop
symptoms of Ebola

33. Ebola hemorrhagic fever
Prevention
Classified as Biosafety level 4 (greatest threat to humans)
Extensive precautions taken when dealing with suspected cases to limit transmission
Several layers of protective clothing covering entire body (up to four)
Complete equipment sterilization
Quarantine of Ebola HF patients

34. Prevention
Healthcare workers who may be exposed to people with Ebola should follow these steps:
1-Wear protective clothing, including masks, gloves, gowns,
and eye protection.
2-Practice proper infection control and sterilization measures.
3-Isolate patients with Ebola from other patients.
4-Avoid direct contact with the bodies of people who have
died from Ebola.

35. Prevention
Notify health officials if you have had direct contact with the blood or body fluids, such as but not limited to, feces, saliva, urine, vomit, and semen of a person who is sick with Ebola. The virus can enter the body through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth

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

37. FIVE TYPES OF HAND HYGEINE

38. ISOLATION PROCEDURES
Select Site for the Isolation Area
Isolation area must consist of :
1)An isolated toilet 2)Adequate ventilation 3)Screened windows
Plan How to Arrange the Isolation Area

39. Thanks for your patience