EBOLA VIRUS DISEASE SITUATION AND ASSESSMENT

GUIDE:

Dr.Laxmikant Lokare

Associate professor

Community Medicine

EBOLA VIRUS OUTBREAK

Presenter: Dr.Ashwini S Pujari

Intern

Background

Ebola virus disease(EVD) causes acute, serious illness if not treated can lead to death.

Formerly known as Ebola hemorrhagic fever.

Case fatality rate in past outbreaks- 25% to 90%

High case fatality rate –transmission from wild animals and human-human transmission.

Five species of Ebola virus : Bundibugyo virus (BDBV). Sudan virus (SUDV). Taï Forest virus (TAFV). Zaire Ebola virus (EBOV). Reston virus.

Past outbreaks EVD first appeared in in 1976 in 2 simultaneous outbreaks –

Nzara, Sudan and Yambuku, DRC. The latter occurred in a village near Ebola(origin of name).

Year CountryEbolavirsspecies Cases Deaths

Case fatality

2012

Democratic Republic of Congo Bundibugyo 57 29 51%

2012 Uganda Sudan 7 4 57%

2012 Uganda Sudan 24 17 71%

2011 Uganda Sudan 1 1 100%

2008

Democratic Republic of Congo Zaire 32 14 44%

2007 Uganda Bundibugyo 149 37 25%

2007

Democratic Republic of Congo Zaire 264 187 71%

Year Country

Ebolavirus

Species Cases DeathsCase fatality

2005 Congo Zaire 12 10 83%

2004 Sudan Sudan 17 7 41%

2003 (Nov-Dec) Congo Zaire 35 29 83%

2003 (Jan-Apr) Congo Zaire 143 128 90%

2001-2002 Congo Zaire 59 44 75%

2001-2002 Gabon Zaire 65 53 82%

2000 Uganda Sudan 425 224 53%

1996South Africa (ex-Gabon) Zaire 1 1 100%

1996 (Jul-Dec) Gabon Zaire 60 45 75%

Year Country Ebola species

Cases Deaths Case fatality

1995

Democratic Republic of

Congo Zaire 315 254 81%

1994 Cote d'Ivoire Taï Forest 1 0 0%

1994 Gabon Zaire 52 31 60%

1979 Sudan Sudan 34 22 65%

1977

Democratic Republic of

Congo Zaire 1 1 100%

1976 Sudan Sudan 284 151 53%

1976

Democratic Republic of

Congo Zaire 318 280 88%

PRESENT OUTBREAK The current outbreak in West Africa is the largest and complex outbreak since

the Ebola virus was first discovered in 1976.

It has spread between countries starting in Guinea then spreading across land borders to Sierra leonne and Liberia, by air(1 traveller only) and by land(1 traveller) to Senegal.

These are the most severly affected countries due to weak health systems.

The index case was a pregnant woman who prepared bushmeat from an animal that had been killed by her husband.

On Aug 8, WHO declared it as “Public Health Emergency of international Concern”.

Zaire species is involved in the present outbreak of Ebola.

Spread of Ebola virus

Cumulative number of cases and deaths

As of 17 October 2014, 9,693 suspected cases and 4,811 deaths. WHO - nos may be vastly underestimated. WHO -216 healthcare workers are dead, partly due to the lack of equipment

and long hours. In Nigeria, there have been 21 cases and 7 deaths. In Senegal, one case has been confirmed and there have been no Ebola

deaths or further suspected cases A separate outbreak of EVD, which is not related to the outbreak in west

Africa, was laboratory-confirmed on 26 August by DRC.

Widespread and intense transmission as at 31 August 2014

Country Case definition Total Total (deaths)Case fatality rate (%)

Guinea Confirmed 579 343 59

Probable 150 149 99

Suspected 42 2 5

All 771 494 64

Liberia Confirmed 403 271 67

Probable 815 373 46

Suspected 480 227 47

All 1698 871 51

Sierra Leone Confirmed 1107 430 39

Probable 37 34 92

Suspected 72 12 17

All 1216 476 39

All All 3685 1841 50

Initial case(s) and localized transmission as at 31 August 2014

CountryCase definition Total Total deaths

Case fatality rate (%)

Nigeria Confirmed 16 6 37.5

Country Case definition Total Total deaths Case fatalityrate(%)

Probable 1 1 100

Suspected 4 0 0

All 21 7 33.3

Senegal Confirmed 1 0 0

Probable 0 0 0

Suspected 0 0 0

All 1 0 0

All All 22 7 31.8

Senegal is now free of Ebola virus transmission

The first confirmed case in Senegal was on 29th August 2014.

Forty-two days have now passed since the last contact of Senegal’s single confirmed case of Ebola virus disease completed the requisite 21-day monitoring period, under medical supervision, developed no symptoms, and tested negative for the virus.

WHO officially declares Senegal free of Ebola virus transmission on 17th

October 2014.

Factors that contributed to success of Senegal

Strong political leadership. Early detection and response. Proper surveillance. Rapid mobilization of resources. Support (WHO). Nationwide public awareness. Multisectoral collaboration. Direct support to patient(social and psychological). Reintegration of recovered patient into society.

VIRULENCE PER OUTBREAK

Virulence per species

VIRULENCE PER COUNTRY

OUTBREAK DEATHS BY SPECIES

ANNUAL DEATHS BY COUNTRY

Important timeline of Ebola outbreak

• March 22: Guinea confirms a previously unidentified hemorrhagic fever, which killed over 50 people in its southeastern Forest Region, is Ebola. One study traces the suspected original source to a 2-year-old boy in the town of Gueckedou. Cases are also reported in the capital, Conakry.

• March 30: Liberia reports two Ebola cases; suspected cases reported in Sierra Leone.• May 26: WHO confirms first Ebola deaths in Sierra Leone.• June 23: With deaths above 350, making the West African outbreak the worst Ebola

epidemic on record, MSF says it is "out of control" and calls for massive resources.• July 25: Nigeria, Africa's biggest economy, confirms its first Ebola case, a man who

died in Lagos after traveling from Monrovia.• Aug. 2: A U.S. missionary physician infected with Ebola in Liberia is flown to Atlanta

in the United States for treatment.• Aug. 5: A second U.S. missionary infected with Ebola is flown from Liberia to

Atlanta for treatment.• Aug. 8: WHO declares Ebola "international public health emergency," stops short of

urging ban on trade and travel.• Aug. 12: WHO says death toll has topped 1,000, approves use of unproven drugs or

vaccines.• A Spanish priest with Ebola dies in a Madrid hospital.

• Aug. 24: Democratic Republic of Congo declares Ebola outbreak in a northern province, apparently separate from larger outbreak.

• An infected British medical worker is flown home from Sierra Leone for treatment.

• Aug. 29: Senegal reports first confirmed Ebola case• Sept. 3: Epidemic's pace accelerates; deaths top 1,900. Officials say there were

close to 400 deaths in the past week.• A third U.S. missionary doctor infected with Ebola is flown out of Liberia for

treatment in Omaha, Nebraska.• Sept. 26 - New WHO tally: 3,091 dead out of 6,574 probable, suspected and

confirmed cases• Sept. 30 - CDC confirms the first diagnosis in the United States of a patient

infected with Ebola. The patient, being treated at a hospital in Dallas, had traveled to West Africa

• Oct. 17 –WHO declares Senegal free of Ebola.• Oct. 20-WHO declares Nigeria free of Ebola.

REFERENCES

• WHO website