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DR. FRANCES R. WURIE-SESAYEBOLA HAEMORRHAGIC FEVERPRESENTATION:
EHFINTRODUCTIONBRIEF HISTORYNATURAL HISTORYMODE OF
TRANSMISSIONSIGNS AND
SYMPTOMSDIAGNOSISTREATMENTPROGNOSISPREVENTIONRECOMMENDATIONSINTRODUCTIONONE
of the many viral haemorrhagic fevers.Caused by the Ebola Virus:
Named after the Ebola River
BRIEF HISTORYEBOV: 26 August 1976 in Yambuku. The first recorded
case was Mabalo Lokela, a 44year-old schoolteacher. SEBOV: cotton
factory workers in Nzara, Sudan, with the first case reported as a
worker exposed to a potential natural reservoirREBOV: Reston
ebolavirus . Discovered during an outbreak of simian hemorrhagic
fever virus (SHFV) in 1989. TAFV: Also referred to as Ta Forest
ebolavirus , it was first discovered among chimpanzees from the Ta
Forest in 1994. One of the scientists contracted Ebola. BEDOV:
Bundibugyo ebolavirus. November 2007--Uganda
DRC 1976Cases: 318Deaths: 280NATURAL HISTORYBats drop partially
eaten fruits and pulp, then terrestrial mammals such as gorillas
and monkeys feed on these fallen fruits. Dead animal(bush) hunter
family(village) community cityOutbreaks are usually traceable to a
single index case where an individual has handled the carcass of
gorilla, chimpanzee, or an infected human corpse.Fruit bats are
also reported to be a treat eaten by people in parts of West
Africa.NATURAL HOST
FRUIT EATING BAT
Cultural DelicaciesGhanaian Savory Dried Bats MODE OF
TRANSMISSION Through close contact with the blood, secretions,
organs or other bodily fluids of infected animals. Through
human-to-human transmission, resulting from close contact with the
blood, secretions, organs or other bodily fluids of infected
people, thru broken skin or mucous membranes.Direct contact with
the body of the deceased infected person. Transmission via infected
semen can occur up to eight weeks after clinical recovery.MODE OF
TRANSMISSION CONTDHealth-care workers have frequently been infected
while treating Ebola patients. (infected sharp objects)
At Risk?????-------health workers and family membersSIGNS AND
SYMPTOMS (S/S)The incubation period (interval from infection to
onset of symptoms) varies between 2 to 21 daysAVG13Sudden onset of
fever, intense weakness, muscle pain, headache and sore throat.
This is followed by vomiting, diarrhoea (w or w/o blood), rash,
impaired kidney and liver function, and in some cases, both
internal and external bleedingINDICATIVE OF NEG PROGNOSIS.
SIGNS AND SYMPTOMS (S/S) CONTDSEIZURESAGITATIONSKIN
MANIFESTATION
SIGNS AND SYMPTOMS (S/S) EPISTAXIS SUBCONJUCTIVAL
HAEMORRHAGE
EVD's most important clinical indicator is the persons medical
history, especially travel and occupational history and the
patient's exposure to wildlife.
SUSPECTED CASE :s/s plus history of travel or contactPROBABLE
CASE: s/s plus history of contact with death without lab inv/
CONFIRMED CASE: after lab diagnosis
DIAGNOSISDIAGNOSTIC METHODSLaboratory findings show low counts
of white blood cells and platelets as well as elevated liver
enzymes. Ebola virus infections can only be diagnosed definitively
in the laboratory by a number of different tests:Enzyme-linked
immunosorbent assay (ELISA) Antigen detection testsSerum
neutralization testReverse transcriptase polymerase chain reaction
(RT-PCR) assayVirus isolation by cell culture.
TREATMENT NO CURE NO VACCINE
TREATMENT IS MAINLY
SUPPORTIVEISOLATIONFLUIDSOXYGENANALGESICSANTIPYRETICSBLOOD
TRANSFUSIONDIFFERENTIAL DIAGNOSIS Malaria Typhoid fever Shigellosis
Cholera Meningitis Hepatitis Other VHFs LASSA FEVER, MARBURG,
CONGO-CRIMEAN
PROGNOSISIn general, outcomes are poor with 68% of all cases
resulting in death; 90% with EBOV If an infected person survives,
recovery may be quick and complete, or prolonged with long term
problems, such as inflammation of the testicles, joint pains, skin
peeling, or alopecia. Eye symptoms, such as light sensitivity,
excess tearing, and blindness have also been described. EBOV and
SUDV may be able to persist in the sperm of some survivors, which
could give rise to secondary infections and disease.PROBABILITY OF
EPIDEMICThe potential for widespread Ebola Viral Diease (EVD)
epidemics could be considered low due to the high case-fatality
rate, the rapidity of demise of patients, and the often remote
areas where infections occur(poor road network)The need to seek
medical assistance may predispose individuals to migrate, thereby
spreading the infection.
THE SIERRA LEONE CONNECTIONFIRST CASELOCATIONCONFIRMEDDEATHSCASE
FATALITY RATEFEB 2014GUINEA32820863%MAR 2014LIBERIA131077%MAY 25,
2014SIERRA LEONE421228.6%SIERRA LEONE CASE TREND SIERRA LEONE
SUSPECTED CASES= 123
PREVENTION Educational public health messages for risk reduction
should focus on several factors.Reducing the risk of
wildlife-to-human transmission from contact with infected fruit
bats or monkeys/apes and the consumption of their raw meat.AVOID
direct or close contact with infected people, particularly with
their bodily fluids. Regular hand washing is required.
PUBLIC AWARENESS CAMPAIGNS
PREVENTIONBarrier nursing techniques include:wearing of
protective clothing (such as masks, gloves, gowns, and goggles)the
use of infection-control measures (such as complete equipment
sterilization and routine use of disinfectant)isolation of Ebola HF
patients from contact with unprotected persons.
PERSONAL PROTECTIVE EQUIPMENTGown or suit (WATERPROOF)Apron
BootsGlovesMask HeadcoverGoogles
HANDWASHING VS. HAND SANITIZER1g of faeces contains 3 trillion
germsE. Coli, Salmonella etc
The virus has a lipid covering. So simple soap and water will
kill it.Hand washing should last 15-30secSanitizer effective with
at least 60% alcohol---right amount/air dry/clean handsTriclosan --
bacterial resistance
less handwashing/sanitizing = more chance to spread disease
DISINFECTION/INFECTION CONTROLSensitive to alcohol, heat, bleach
(concentration)----1:10 and 1:100 UNIVERSAL NURSING BARRIERSSafe
sharps disposalIncinerationABERDEEN WOMENS CTR (AWC) ISOLATION
UNIT
AWC ISOLATION UNIT
BEING CAUTIOUSIf someone vomits in branch/officeUse gloves to
clean and dispose of clean up in toilet and flushDO NOT DISPOSE OF
IN GUTTER OR PUBLIC AREAIf someone is bleeding from
nose/ears/mouthDO NOT ASSIST WITHOUT THE USE OF GLOVESREFER TO
NEAREST HOSPITALProvincial DriversHave gloves in your cars if you
need to assist anyone with the symptomsLoan/Relationship/Marketing
OfficersAlways have sanitizer and use before entering
households/businessesBe aware of the sign and symptoms and look for
them in your surroundingsWear long sleeves when in taxis or public
transportRECOMMENDATIONSSTAFF: NORMAL PERONAL HYGIENE---BATHROOM
USESTAFF: FREQUENT AND PROPER HANDWASHING ---AIR DRY OR DISPOSABLE
PAPER TOWELSCASHIERS SHOULD USE GLOVESFREQUENTLY WIPE DOWN WITH
BLEACH DOOR HANDLES, CASHIER/CSO COUNTERS, AND ANY AREA WHERE THERE
IS HIGH TRAFFIC. USE GLOVES.SANITIZER USE BEFORE ENTRY FOR
CUSTOMERSSANITIZER USE THROUGHOUT THE DAYRECOMMENDATIONSLIMIT
HANDSHAKING, HUGGINGSTAFF IN THE EAST SHOULD BE EXTRA
CAUTIOUSMONITOR VISITORS FROM PROVINCIAL AREAS AVOID CONTACT WITH
SICK PEOPLE
THANK YOU!
QUESTIONS & COMMENTS
