EBOLA Haemorrhagic Fever

DR.SATTI MOHAMMED SALEHMEEQAT HOSPITAL MEDICAL DIRECORINFECTION CONTROL DIRECTORCBAHI SIT MEMBER

What are viral hemorrhagic fevers?

(VHFs )refer to a group of illnesses that are caused by several distinct families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem syndrome (multisystem in that multiple organ systems in the body are affected). Characteristically, the overall vascular system is damaged, and the body's

ability to regulate itself is impaired

CLASSIFICATION OF VIRAL HEMORRHAGIC FEVER ACCORDING TO MODES OF TRANSMISSION

ETIOLOGICAL VIRUS DISEASES MODE OF TRANSMISSIONYellow feverDengue types 1-4Chikunguny a rift valley fever

Yellow feverDengue feverChikunguny a hemorrhagic fever

Mosquito borne

Congo-Crimean hemorrhagic fever kyasanur forest disease Omsik hemorrhagic fever

Crimean hemorrhagic fever kyasanur forest disease a Omsk hemorrhagic disease

Tick borne

Junin MachupoLassa

Argentine hemorrhagic fever Bolivian hemorrhagic fever- Lassa fever

Zoonotic

Hanta anMarburgEbola

Korean hemorrhagic feverMarburg virus diseaseEbola virus disease

Unknown

Filoviridae(Ebola, Marburg)

Arenaviridae(Lassa, Junin, Machupo, Guanarito)

Bunyaviridae(CCHF, RVF,

Hantaviruses)

Viral Haemorrhagic Fevers

Flaviviridae(dengue, yellow fever,

TBE encephalitides)

EnvelopedRNA viruses

• Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees).

Ebola Virus(Filoviridae Family)

3Genere1- Ebola Virus2- Marburgvirus3- Cuevasirus ( NEW

Ebola Virus Genus Consists of 5 species

• 1- Zaire• 2- Sudan• 3- Reston• 4- Taiforest• 5- Bundibugyo( New)

reservoir

•The natural host of ebola viruses, and the manner in which transmission of the virus to humans occurs, remain unknown. This makes risk assessment in endemic areas difficult. With the exception of several laboratory contamination cases (one in England and two in Russia), all cases of human illness or death have occurred in Africa; no case has been reported in the United States.

All filoviruses are classified as :

• All filoviruses are classified as :• Category A select agent pathogens in USA• 1- Easily transmitted between Humans• 2- Cause High Mortality ( 40-90%) • 3- Potential for Major Public Health Impact • 4- High public panic and disruption • 5- Concern for use as Bioterror weapon

Need BSL for LAB to provide highest level of protection for both lab workers and environment

Epidemiology :

• MURBURG HF ( first filovirus ) In Germany and Yugoslavia 1967

• From primates imported from Uganda 31 cases, 23% mortality

• Largest outbreak of MURBURG in Angola 2005, 250 cases 90% mortality

large outbreak

• Ebola HF first 2 large outbreak simultaneously 1976

• Democratic Republic of Congo • Southern Sudan • Caused by 2 separate species ;• Zaire ( EBOV) and Sudan ( SUDV)

Other 3 species of EBOLA : ( TAI, RESTON, BUNDIBUGYO

• ) • Occurred less frequently • TAI only single non fatal infection ) • (AUTOPSY OF DEAD CHIMPANZEES)

• A host of similar species is probably associated with Reston virus, which was isolated from infected cynomolgous monkeys imported to the United States and Italy from the Philippines. Several workers in the Philippines and in US holding facility outbreaks became infected with the virus, but did not become ill.

Transmission and Pathogenesis and Pathology

• Spread by close contact with sick patients• Virus containing bodily fluids Includes • *Blood * Semen• * Vomitus *Breast milk• *Saliva *Tears • *Stool

Transmission Requires

• Close contact with blood, body fluid and mucous Membranes Exposure

• No true Aerosol transmission • No transmission in asymptomatic

patients during incubation Period

Severe Diseases Attributed to

• :

• 1- Rapid Viral Replication • 2- Host immune suppression • 3- Vascular Dysfunction

Incubation period

• 2-21 days.

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Case definition-WHO/CDC

Anyone presenting with fever and signs of bleeding such as:• • Bleeding of the gums• • Bleeding from the nose• • Red eyes• • Bleeding into the skin (purple coloured patches in the skin)• • Bloody or dark stools• • Vomiting blood• • Other unexplained signs of bleeding• Whether or not there is a history of contact with a suspected

case of EHF.22

OR Anyone living or deceased with:• Contact with a suspected case of EHF AND• A history of fever, with or without signs of bleeding.

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• OR• Any unexplained death in an area with suspected cases of

EHF.

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Lab findings • Leucopenia.• Thropocytopenia.• Elevated liver enzymes.

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Lab diagnosis

• Specific antigen detection.• Viral gene detection.• Antibodies detection (IgM for recent infection).• Viral isolation (BSL-4 Lab.).• Non-invasive methods of detection (saliva and urine sample).

• Postmortem by immunohistochemical exam. Of skin or autopsy specimen.

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Therapy

• No specific ttt• No vaccine

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Containment

• Isolate suspected cases from other patients.• Tracing and follow up people exposed to Ebola cases.• Health staff Orientation and using PPE.• Health staff Precaution for invasive technique and body

secretions.• Inform public about disease nature and burial of deceased.• Strict surveillance of contacts.

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Patient Placement

•Single patient room (containing a private bathroom) with the door closed

•Facilities should maintain a log of all persons entering the patient's room

•Consider posting personnel at the patient’s door to ensure appropriate and consistent use

of PPE by all persons entering the patient room

Personal Protective Equipment (PPE)

•All persons entering the patient room should wear at least:–Gloves–Gown (fluid resistant or impermeable)–Eye protection (goggles or face shield)–Facemask

•Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces

present in the environment), including but not limited to:–Double gloving–Disposable shoe covers–Leg coverings

Challenges

• Additional diagnostic tools.• Ecological investigations and possible reservoirs.• Monitor suspected cases to determine disease incidence.• Natural reservoirs and how virus spread.

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THANK YOU

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