Prevention of Ebola virus

infection

Outline

Structure
Pathogenesis
Incubation period
Clinical features
Early
Late

Diagnosis
Prevention
Treatment

Structure of Ebola virus

Countries
known to be
endemic for
Ebola virus

Pathogenesis
Source of infection
Route of entry
Incubation period 2-21 days

Virus enters body

Infects macrophages, dendritic cells,
monocytes
Multiply lymphnodes, hepatocytes, spleen
Cytokine Storm
Cytokines-TNF-, IL-1, IL-6
Vasodilatati
on
Endothelial damage
Vascular
permeability
Platelet aggregation
Hypotension

Clinical features
Early symptoms(1-3 days)
Fever

Malaise Nausea

Headac
he

Later stage -5-7days

Petechiae - Ecchymosis

Vomitin
g

Diarrho
Cough
ea

Bleedin
g

6090%
6-11
days

Mortality
Non-fatal
cases recover

Suspected
headache,
case
vomiting,

diarrhea,
abdominal
Had comepain,
in
or
unexplained
contact
Travel
to with
West
AND
hemorrhage
blood
or other
Africa
(Guinea,
body fluids
or
Liberia,
Nigeria,
human
remains
Senegal,
Sierra
of a patient
Leone
) within
known
to have
21 days
(3

Confirmed case

Laboratory diagnosis

-Gloves
-Gowns - fluid resistant
-Eye protection - goggles
-Mask to cover
-Shoe and leg covers.

PPE

Sample collection
Specimen
Whole blood -4ml

Stored or transported at 2-8C to the

Lab.

Retrospectively in deceased patients

Samples (Postmortem)
Tissue sample (liver, spleen, bone
marrow, kidney, lung and brain)

 Basic triple packaging system

Primary container (a sealable specimen
bag) wrapped with absorbent material
Secondary container (watertight, leakproof),
Outer shipping package.

Non-specific
Leucopenia
Thrombocytopenia
Elevated serum AST
Elevated ALT

Specific tests

RT-PCR (Reverse transcriptase-PCR)

High sensitivity and specificity

Detectable levels - 3 days after fever

 Serology-ELISA
Viral isolation(Culture)

Management
Maintain hydration(IV fluids)
Balancing electrolytes
Maintaining oxygen status and blood
pressure
Treating other infections if they occur

Drugs experimental stage

July 2013 (Petit et al) Cocktail
Humanized monoclonal antibodies
Infected monkeys recovered (43%)

 Produced by MAPP Biopharmaceutical

Inc.
The initial response appears positive.

Survivors
Kent Brantley

Nancy Writebol

ts
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 ZMapp has not yet been tested in a

clinical trial
Dr. Salim S. Abdool Karim

(Director -of an AIDS

research center,SA),

It would have been the front-page

screaming headline: 'Africans used as
guinea pigs for American drug
companys medicine.

 William Pooley, a 29
year old British nurse
who had been working
as a volunteer at
Shepherds Hospice in
Freetown, Sierra
Leone

 TKM-Ebola
RNA interference drug

Post exposure prophylaxis

Under trial

Ebola survivors serum transfusion

therapy

Expanded access
Also known as compassionate use
Use of an investigational drug outside
of a clinical trial by patients with
serious or life-threatening conditions.

Prevention

Health education

Avoid contact with infected persons

blood and body fluids

Avoid funeral or burial rituals that require

handling the body

Avoid contact with bat /bush

meat

Case finding

Isolate patients Barrier

nursing

Vaccines?
In 2003- vaccine - Adenovirus
carrying Ebola spike protein
In 2005 VSV-EBOV
Attenuated recombinant Vesicular
stomatitis virus(VSV) Ebola
glycoprotein.

Under phase I trial

Ebola in
India ???!!!!!

Are we Prepared???

45,000 Indians countries afected

by Ebola virus

Airport authority of India

Passengers - 4 endemic countries are

enquired

If suspected, Quarantine 3 weeks

India
National institute of virology, Pune
RT-PCR
Samples tested so far -7 (Negative)

National Centre for Disease Control,

Delhi
RT-PCR

 Latest case report- 18/11/2014

Thank you

Questions
1. The following countries are endemic to Ebola Virus infection
except
A.
B.
C.
D.

Liberia
Republic of Guinea
Nigeria
United States of America

2. Ebola virus takes its name after the name of a

A.
B.
C.
D.

Sea
River
Lake
Person

3. The common methods of spread of Ebola virus infection is by

A.
B.
C.
D.

Aerosol
Contact with body fluids
Sexual transmission
All of the above

4. Wearing Personal Protective

Equipment (PPE) is optional for
health care professionals handling
patients infected with Ebola virus
A. True
B. False

5. The consumption of the following

meat causes Ebola virus infection
A.
B.
C.
D.

Chicken
Pork
Bush meat
All of the above

6. The duration of quarantine for

people infected with Ebola virus
infection is
A.
B.
C.
D.

10
15
21
16

days
days
days
days

7. We should wear double gloves while

handling patients with Ebola virus
infection
A. True
B. False

8. Which of the following methods are used

for transporting the clinical samples of
Ebola virus infection?
A.
B.
C.
D.

Single packaging system

Double packaging system
Triple packaging system
Quadruple packaging system

9. Which drug is used for treating Ebola virus

infection?
A.
B.
C.
D.

Acyclovir
YMAPP
ZMAPP
Gancyclovir

10.Screening quarantine at airports for

people coming to India from Ebola
endemic countries is mandatory
A. True
B. False