1. Ebola Virus Disease (EVD)

2. Marburg and Ebola Virus Hemorrhagic Fevers Filovirus RNA virus Threadlike, filamentous morphology Viral epidemics from Africa and a source in the Phillippines Humans, monkeys, chimpanzees and gorrillas are the major disease targets

3. Ebola Virus Disease (EVD) ▶ Formerly known as Ebola hemorrhagic fever ▶ Severe, often fatal in humans –Outbreaks have a case fatality rate < 90% Median 60% –Outbreaks usually occur in remote villages of Central and West Africa

4. EVD Outbreaks 4

5. Ebolavirus Outbreaks 5

6. Ebolavirus 6

7. Human Infection Direct Contact Blood Secretions Organs Other body fluids Indirect Contact Contaminated environments Airborne Transmission Hypothetical during aerosol generating procedures 7

8. EVD Transmission 1976 Zaire Ebola epidemic Driven by the use of improperly sterilized needles and syringes, resulting in much of the geographic spread of infection Person to person spread was extensive among medical staff, often resulting in closure of hospitals and clinics 8

9. EVD Transmission 1976 Zaire Ebola epidemic Subsided with the use of properly sterilized equipment, closure of hospitals, education of the population, and institution of mask-gown- glove precautions 9 Dowell SF, Mukunu R, Ksiazek TG, et al.: Transmission of Ebola hemorrhagic fever: A study of risk factors in family members, Kikwit, Zaire 1995. J Infect Dis. 179 (Suppl 1):S87-S91 1999 World Health Organization: Ebola haemorrhagic fever in Zaire, 1976: Report of an international commission. Bull World Health Organ. 56:271-293 1978 Khan AS, Kweteminga TF, Heymann DH, et al.: The reemergence of Ebola hemorrhagic fever (EHF), Zaire, 1995. J Infect Dis. 179 (Suppl 1):S76-S86 1999

10. You Can’t Get Ebola From

11. EVD Incubation Period 2 – 21 days (mean 8 - 10 days) Acute onset Fever (> 38 o 6C/>101.5 o F), myalgia, headache After about five days Nausea and vomiting Abdominal pain Diarrhea Chest pain, cough, pharyngitis 11

12. EVD Other features Photophobia Lymphadenopathy Conjunctivitis Jaundice Pancreatitis CNS Symptoms Decreased mental status, delirium, coma 12

13. EVD As disease progresses Erythematous maculopapular rash face, neck, trunk, arms desquamation Bleeding manifestations petechiae, ecchymosis hemorrhage less common Shock, DIC, liver and renal failure Death between six and 16 days Protracted convalescence Arthralgia, orchitis, uveitis, transverse myelitis 13

14. EVD Infectious as long as ebola virus present in blood and secretions Can be up to 61 days in semen 14

15. Diagnosis Travel + Exposure history Progressive abdominal pain + diarrhea Rash Thrombocytopenia, leukopenia, lymphompenia Elevated transaminases: AST > ALT Elevated amylase, D-dimer, low albumin Prolonged PT, PTT Viral culture during acute stages Seroconversion during second week of illness 15

16. CDC Case Definition – Suspect Case 1.Clinical Criteria Fever > 38.6 o C or >101.5 o F Symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage AND 2.Epidemiologic risk factors within the past 21 days before the onset of symptoms Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD Residence in—or travel to—an area where EVD transmission is active Direct handling of bats, rodents, or primates from disease-endemic areas 16

17. CDC Case Definition - Contacts 1.High Risk Exposure Percutaneous or mucous membrane exposure to body fluids of EVD patient Direct care or exposure to body fluids of an EVD patient without appropriate PPE Laboratory worker processing body fluids of confirmed EVD patients without appropriate PPE or standard biosafety precautions Participation in funeral rites which include direct exposure to human remains in the geographic area where outbreak is occurring without appropriate PPE 2.Low Risk Exposure Household member or other casual contact with an EVD patient Providing patient care or casual contact without high-risk exposure with EVD patients in health care facilities in EVD outbreak affected countries 17

18. EVD Treatment Supportive Maintenance of hydration Replacement of coagulation factors and platelets as indicated Treatment of DIC Monkey models activated protein C improved survival recombinant inhibitor of the tissue factor–activated factor VII complex improved survival 18 Hensley LE, Stevens EL, Yan SB, et al.: Recombinant human activated protein C for the postexposure treatment of Ebola hemorrhagic fever. J Infect Dis. 196 (Suppl 2)):S390-S399 2007 Geisbert TW, Hensley LE, Jahrling PB, et al.: Treatment of Ebola virus infection with a recombinant inhibitor of factor VIIa/tissue factor: A study in rhesus monkeys. Lancet. 362:1953-1958 2003

19. Infection Prevention Contact + Droplet Isolation (with a twist) Surgical mask (N95 respirator if aerosol generating procedure) Eye protection with goggles/face shield Fluid resistant gowns 12” Gloves (double glove) Leg and foot protection if diarrhea, vomiting, hemmorhage Cleaning with bleach Exposure Wash, wash and wash again Twice daily fever check-up for 21 day s 19

20. Putting On and Taking Off Putting On 1. Gown 2. Mask or N95 Respirator 3. Face Shield 4. Gloves Removing 1. Gloves 2. Face Shield 3. Gown 4. Mask or N95 Respirator 20

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