ebola in sierra leon: from the origin and transmission to clinical outcomes
TRANSCRIPT
Stephen Gire, MPH
Harvard UniversityFrom the origin and transmission to clinical outcomes
Ebola in Sierra Leone
Suzuki, Y. & Gojobori, T. The origin and evolution of Ebola and Marburg viruses. Mol Biol Evol 14, 800-806 (1997)
Marburg and Ebola diverged
nearly 10,000 years ago
Filoviruses have ancient origins
Origin and transmission of 2014 EVD outbreak
West African Ebola virus diverged from Central African lineages c. 2004
Diversity data consistent with single importation events from the reservoir
Ebola crosses from Guinea to Sierra Leone - 2 distinct clades enter via 12 travelers
Sierra Leone falls into three main genetic clusters
NS
S
NC
GUINEASIERRA LEONE CLUSTER 1
SIERRA LEONE CLUSTER 2
SIERRA LEONE CLUSTER 3
NP VP35 VP40 GP VP30 VP24 L POLYMERASE
An early and robust IgG response is indicative of survival
Baize, S. et al. Defective humoral responses and extensive intravascular apoptosis are associated with fatal outcome in Ebola virus-infected patients. Nature medicine 5, 423-426(1999)
Supportive care and clinical monitoring of EVD patients
Intravenous fluid therapy (100%)
Anti-malarial treatment (55%)
Antibiotic treatment (93%) - mainly ceftriaxone
Pain relief (27%) - paracetamol
Conventional PCR
qPCR retrospectively
Clinical symptoms
Vitals
Supportive Care
Diagnosis
Clinical monitoring
Metabolic panel
n=44
Elevation of CRE and BUN is significant both to EVD and
outcome
Significance to EVD Significance to outcome
Dehydration and worsening renal function play significant role in
disease progression
Extensive liver damage from Ebola is often fatal
Significance to EVD Significance to outcome
ALT and AST significant to EVD; AST significant to outcome