1. Prepared By: Dr. Amal Abu Alhommos Clinical Pharmacist/Lecturer
Ebola virus
Prepared By:
Dr. Amal Abu Alhommos
Clinical Pharmacist/Lecturer

2. 16/07/1438

3. Background
Ebola previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees).
The natural reservoir host of Ebola virus remains unknown. However, researchers believe that the virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in an animal host native to Africa.
Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.
The current outbreak in west Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak. It borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.
The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The virus causing the 2014 west African outbreak belongs to the Zaire species.
16/07/1438

4. Transmission
Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
16/07/1438

5. What does “direct contact” mean?
What are body fluids?
Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen.
What does “direct contact” mean?
It means that body fluids (blood, saliva, mucus, vomit, urine, or feces) from an infected person (alive or dead) have touched someone’s eyes, nose, or mouth or an open cut, wound, or abrasion.
Can Ebola be spread by coughing or sneezing?
There is no evidence indicating that Ebola virus is spread by coughing or sneezing.  The virus is not transmitted through the air (like measles virus). However, droplets (e.g., splashes or sprays) of respiratory or other secretions from a person who is sick with Ebola could be infectious.
16/07/1438

6. How long does Ebola live outside the body?
Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dry surfaces, such as doorknobs and countertops, can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature.
Are patients who recover from Ebola immune for life? Can they get it again - the same or a different strain?
Recovery from Ebola depends on good supportive clinical care and a patient’s immune response. Available evidence shows that people who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer.
No evidence if people who recover are immune for life or if they can become infected with a different species of Ebola.
If someone survives Ebola, can he or she still spread the virus?
Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months.
16/07/1438

7. Can Ebola be spread through mosquitos?
There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.
16/07/1438

8. Diagnosis
It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:
Antibody-capture enzyme-linked immunosorbent assay (ELISA)
Antigen-capture detection tests
Serum neutralization test
Reverse transcriptase polymerase chain reaction (RT-PCR) assay
Electron microscopy
Virus isolation by cell culture.
Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions.
16/07/1438

9. 16/07/1438

10. Symptoms of Ebola Fever Severe headache Muscle pain Weakness Diarrhea
Vomiting
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)
Symptoms appear from 2 to 21 days after exposure to Ebola, but average is 8 to 10 days.
Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.
16/07/1438

11. Treatment and Vaccines
Supportive care-rehydration with oral or intravenous fluids and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.
No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing.
16/07/1438

12. Prevention and Control
Risk reduction messaging 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. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
Outbreak containment measures including prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.
16/07/1438

13. Controlling Infection In Health-Care Settings
Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.
16/07/1438

14. Previous Ebola Virus Disease Outbreaks
16/07/1438

15. 16/07/1438

16. Personal Protective Equipment (PPE) Guidelines For Ebola Response
“These guidelines hold an important role in clarifying effective personal protective equipment options that protect the safety of healthcare workers and patients from Ebola virus disease transmission,” says Edward Kelley, WHO Director for Service Delivery and Safety.
It was most important to have PPE that protects the mucosae – mouth, nose and eyes – from contaminated droplets and fluids.
Given that hands are known to transmit pathogens to other parts of the body, as well as to other individuals, hand hygiene and gloves are essential, both to protect the health worker and to prevent transmission to others. Face cover, protective foot wear, gowns or coveralls, and head cover were also considered essential to prevent transmission to healthcare workers.
16/07/1438

17. 16/07/1438

18. Isolate patients with Ebola from other patients.
Healthcare workers who may be exposed to people with Ebola should follow these steps:
Wear appropriate PPE.
Practice proper infection control and sterilization measures. For more information.
Isolate patients with Ebola from other patients.
Avoid direct contact with the bodies of people who have died from Ebola.
Notify health officials if you have had direct contact with the blood or body fluids, such as but not limited to, feces, saliva, urine, vomit, and semen of a person who is sick with Ebola. The virus can enter the body through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth
16/07/1438

19. How Do I Know If I Have Seasonal Influenza Or Ebola?
Seasonal influenza and Ebola virus infection can cause some similar symptoms.
However, fall and winter is the time for flu. While the exact timing and duration of flu seasons vary, outbreaks often begin in October and can last as late as May. Most of the time flu activity peaks between December and February.
There are tests to detect seasonal influenza and Ebola infection and should ask about recent travel or exposure history.
16/07/1438

20. How Do I Protect Myself Against Ebola?
Wash hands frequently or use an alcohol-based hand sanitizer.
Avoid contact with blood and body fluids of any person, particularly who is sick.
Do not handle items that may have come in contact with an infected person’s blood or body fluids.
Do not touch the body of someone who has died from Ebola.
Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.
Avoid facilities in West Africa where Ebola patients are being treated.
Seek medical care immediately if you develop fever, headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.
16/07/1438

21. Should People Traveling To Africa Be Worried About Outbreak?
Avoid all nonessential travel to Guinea, Liberia, and Sierra Leone, Democratic Republic of the Congo (DRC).
Ebola is a very low risk for most travelers : it is spread through direct contact with the blood or other body fluids of a sick person, so travelers can protect themselves by avoiding sick people and facilities in West Africa where patients with Ebola are being treated.
16/07/1438

22. What is ZMapp?
ZMapp, being developed by Mapp Biopharmaceutical Inc., is an experimental treatment, for use with individuals infected with Ebola virus. It has not yet been tested in humans for safety or effectiveness. The product is a combination of three different monoclonal antibodies that bind to the protein of the Ebola virus. It is not vaccine.
It's important to note that the standard treatment for Ebola remains supportive therapy. This includes the following measures:
Balancing the patients' fluids and electrolytes;
Maintaining their oxygen status and blood pressure; and
Treating them for any complicating infections.
In addition, the most effective way to stop the current Ebola outbreak in West Africa is isolating and caring for those patients, and tracing contacts to stop chains of transmission.
16/07/1438

23. References http://www.who.int/mediacentre/factsheets/fs103/en/
16/07/1438