DR I.O.LAWAL MBChB(Ife),FWACS(Urol)

EBOLA VIRUS DISEASE Introduction Epidemiology Transmission Signs & Symptoms Diagnosis Differentials Treatment/ Health Education Outbreaks/Conclusion

Introduction A severe, fatal illness in humans with case fatality of up to 90%. A variety of viral Heamorrhagic fever Seen mainly in central and West Africa Highly Contagious, with highest risk to health workers and relations of infected patients. Current outbreak started in December, 2013, but not detected until March, 2014.

Epidemiology Ist appeared in two simultaneous outbreaks in 1976: Nzara (Sudan) & Yambuku ( a village near Ebola river in DR Congo). Genus Ebola Virus is 1 of 3 members of filoviridae along with genus Marburgvirus & genus Cuevirus. Genus Ebola Virus has 5 Species: Bundibugyo virus, Zaire Ebola virus, Sudan Ebola virus, Tai Ebola virus and Reston Ebola virus. The 1st 3 has been associated with large outbreaks. Current outbreak due to Zaire Ebola virus. Reston Species is found in Phillipines & China; can infect humans, but no illness or human deaths has been reported to death.

Transmission Natural host includes infected animals: Fruit bats, Monkeys, forest antelopes, Gorillas & Chimpanzees. Transmitted to man by contact with any of the above. Human-Human transmission occur rapidly by contact with body secretions of infected person- blood, Saliva, faeces, vomittus, sweats and semen. Further spread during Burial ceremony Recuperating man can infect partner up to 7 weeks from coitus. Incubation period is from 2-21 days.

Signs and Symptoms Fever Severe Headache Muscle pains Weakness Diarrhoea Vomitting Abdominal pains Lack of apetite Rashes Red eyes Hiccups Sore throat Difficulty in breathing Bleeding from mucous membranes.

Diagnosis High index of Suspicion History of Contact /History of Travel Signs and Symptoms Confirmatory test: *Antigen-capture enzyme linked immuno-sorbent assay (ELISA) *IgM ELISA *Polymerase Chain Reaction (PCR) *Virus isolation In deceased patients: Immuno-histochemistry, Virus isolation and PCR.

Differentials Malaria fever. Typhoid fever Hepatitis infection Meningitis Other Viral Heamorrhagic fever like Lassa fever, Dengue fever.

Treatment NO KNOWN TREATMENT AT PRESENT Present Treatment regime is supportive: * Fluids & Electrolyte therapy *Maitain Oxygen saturation * Nutritional support * Administration of anti-coagulants. *Treat other complications that may arise.

Health Education Barrier Nursing technique Wearing of protective clothing( mask, gloves, gowns, & goggles). Routine use of disinfectants. Isolating patients with Ebola virus from population. Quarrantine infected patients. Surveillance of contacts.

Present Outbreak COUNTRYCASESDEATHS Guinea Liberia Sierra Leone Nigeria12 (?10)4

Outbreaks: Previous YEARCOUNTRYSPECIESCASESDEATHSFATALITY 2012DR CONGO Bundibugy o % 2012UGANDASudan7457% 2012UGANDASudan241771% 2011UGANDASudan11100% 2008DR CONGO Zaire321444% 2007UGANDABundibugy o % 2007DR CONGO Zaire % 2005DR CONGO Zaire121083% 2004Sudansudan17741% 2003(Nov- Dec) DR CONGO Zaire352983% 2003( Jan- April) DR CONGO Zaire % DR CONGO Zaire655382%

Outbreaks: Previous YEARCOUNTRYSPECIESCASESDEATHSFATALITY GabonZaire655382% 2000UgandaSudan % 1996SA ex- Gabon zaire11100% 1996-Jul/DeGabonZaire604575% Jan/Ap GabonZaire312168% 1995DR CONGO Zaire % 1994Cote d’Ivoire Tai Forest100% 1994GabonZaire523160% 1979Sudan % 1977DR CONGO Zaire11100% 1976Sudan % 1976DR CONGO Zaire %

Conclusion- Take Home Ebola Virus has very high fatality, over 90% No known cure at present No known vaccines. Approved experimental drug:-Z-mapp(on trial) Same for Nano-Silver drug ??( in Nigeria only). Bitter kola does not cure Ebola virus disease. Salt water does not prevent or cure Ebola virus disease PREVENTION IS STILL BETTER-PERSONAL HYGIENE, AVOID CONTACT, CULTURAL/RELIGIOUS PRACTICES.