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Prevention of Ebola virus infectionOutlineStructure Pathogenesis Incubation periodClinical featuresEarlyLateDiagnosisPreventionTreatment

Structure of Ebola virus

Countries known to be endemic for Ebola virus

PathogenesisSource of infection

Route of entry

Incubation period 2-21 daysVirus enters bodyInfects macrophages, dendritic cells, monocytesMultiply lymphnodes, hepatocytes, spleenCytokines-TNF-, IL-1, IL-6Endothelial damagePlatelet aggregation DIC Vascular permeabilityVasodilatationHypotensionCytokine Storm

Clinical featuresEarly symptoms(1-3 days)

FeverNauseaMalaiseHeadacheLater stage -5-7days

Petechiae - Ecchymosis

VomitingDiarrhoeaBleeding Cough

ANDSuspected caseConfirmed caseLaboratory diagnosis

PPE

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

Sample collectionSpecimenWhole blood -4ml

Stored or transported at 2-8C to the Lab.

Retrospectively in deceased patientsSamples (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, leak-proof),

Outer shipping package.

Non-specificLeucopenia

Thrombocytopenia

Elevated serum AST

Elevated ALTSpecific tests

RT-PCR (Reverse transcriptase-PCR)High sensitivity and specificity

Detectable levels - 3 days after fever

Serology-ELISA Viral isolation(Culture)

ManagementMaintain hydration(IV fluids)

Balancing electrolytes

Maintaining oxygen status and blood pressure

Treating other infections if they occur

Drugs experimental stageJuly 2013 (Petit et al) Cocktail

Humanized monoclonal antibodies

Infected monkeys recovered (43%)

Produced by MAPP Biopharmaceutical Inc.The initial response appears positive.

SurvivorsKent BrantleyNancy Writebol

5 days after Ebola affects American,Cure foundZMapp 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-EbolaRNA interference drug

Post exposure prophylaxis

Under trialEbola survivors serum transfusion therapy

Expanded accessAlso known as compassionate use

Use of an investigational drug outside of a clinical trial by patients with serious or life-threatening conditions.

PreventionHealth 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

In 2003- vaccine - Adenovirus carrying Ebola spike protein

In 2005 VSV-EBOVAttenuated recombinant Vesicular stomatitis virus(VSV) Ebola glycoprotein.

Under phase I trialVaccines?

Ebola in India ???!!!!!Are we Prepared???

45,000 Indians countries affected by Ebola virus Airport authority of IndiaPassengers - 4 endemic countries are enquired

If suspected, Quarantine 3 weeks

India National institute of virology, PuneRT-PCRSamples tested so far -7 (Negative)

National Centre for Disease Control, DelhiRT-PCR

Latest case report- 18/11/2014Thank youQuestionsThe following countries are endemic to Ebola Virus infection exceptLiberiaRepublic of GuineaNigeriaUnited States of AmericaEbola virus takes its name after the name of aSeaRiverLake PersonThe common methods of spread of Ebola virus infection is by AerosolContact with body fluidsSexual transmissionAll of the aboveWearing Personal Protective Equipment (PPE) is optional for health care professionals handling patients infected with Ebola virusTrueFalseThe consumption of the following meat causes Ebola virus infectionChickenPorkBush meatAll of the aboveThe duration of quarantine for people infected with Ebola virus infection is 10 days15 days21 days16 daysWe should wear double gloves while handling patients with Ebola virus infectionTrueFalseWhich of the following methods are used for transporting the clinical samples of Ebola virus infection?Single packaging systemDouble packaging systemTriple packaging systemQuadruple packaging systemWhich drug is used for treating Ebola virus infection?AcyclovirYMAPPZMAPPGancyclovir

Screening quarantine at airports for people coming to India from Ebola endemic countries is mandatoryTrueFalse