Download the viruses among us - Almaden Valley Community Association

1
THE VIRUSES
AMONG US
NOVEMBER 10, 2014
Alfonso F. Banuelos, Jr. MD
Santa Clara Valley Medical Center
11/14/2014
Virus
2

A virus is a small infectious agent that replicates only inside the living cells of other
organisms. Viruses can infect all types of life forms, from animals and plants to
bacteria.

Dmitri Ivanovsky's 1892 article describing a non-bacterial pathogen infecting tobacco
plants, and the discovery of the tobacco mosaic virus by Martinus Beijerinck in 1898,
about 5,000 viruses have been described in detail, although there are millions of
different types. Viruses are found in almost every ecosystem on Earth and are the
most abundant type of biological entity. The study of viruses is known as virology, a
sub-speciality of microbiology.

Virus particles (known as virions) consist of two or three parts:

the genetic material made from either DNA or RNA, long molecules that carry
genetic information;

a protein coat that protects these genes; and in some cases
an envelope of lipids that surrounds the protein coat when they are outside a cell.
The shapes of viruses range from simple helical and icosahedral forms to more
complex structures. The average virus is about one one-hundredth the size of the
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average bacterium.
From Wikipedia
2014

Virus vs. Bacteria
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http://socratic.org/questions/how-do-bacteria-differ-from-a-virus
Viruses vs. Bacteria
4
http://socratic.org/questions/how-do-bacteria-differ-from-a-virus
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Viral vs. Bacterial Reproduction
5
www.microbeworld.org/what-is-a-microbe/viruses
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6
ABOUT INFLUENZA
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Influenza Virus
7
Structure of influenza virus
30 APRIL 2009
The virus particle is 80–120 nanometers in diameter and usually roughly spherical,
although filamentous forms can occur.
http://www.virology.ws/2009/04/30/structure-of-influenzavirus/
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Ebola Virus
8
The overall cylinders are generally approximately 80nm in diameter, and
having a virally encoded glycoprotein (GP) projecting as 7-10 nm long
spikes from its lipid bilayer surface.[7] The cylinders are of variable length,11/14/2014
typically 800 nm, but sometimes up to 1000 nm long.
Influenza Symptoms
9

Influenza (also known as the flu) is a contagious respiratory
illness caused by flu viruses. It can cause mild to severe
illness, and at times can lead to death. The flu is different
from a cold. The flu usually comes on suddenly. People who
have the flu often feel some or all of these symptoms:
Fever* or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (tiredness)
Some people may have vomiting and diarrhea, though this is more
common in children than adults.

* It's important to note that not everyone with flu will have a
fever.
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CDC: Centers for Disease Control and
Influenza Complications
10
How many people die from seasonal flu each year in the United States?

The number of seasonal influenza-associated (i.e., seasonal flu-related)
deaths varies from year to year because flu seasons are unpredictable and
often fluctuate in length and severity. Therefore, a single estimate cannot
be used to summarize influenza-associated deaths. Instead, a range of
estimated deaths is a better way to represent the variability and
unpredictability of flu.

CDC estimates that from the 1976-1977 season to the 2006-2007 flu
season, flu-associated deaths ranged from a low of about 3,000 to a high of
about 49,000 people. About 90% of influenza associated deaths occur
among adults 65 years and older.

CDC has estimated the global death toll from the 2009 H1N1 influenza
pandemic at more than 284,000, about 15 times the number of laboratoryconfirmed cases. Estimated that 80% of those who died were younger than
65, which is in accord with previous observations that the pandemic H1N1
burden fell heavily on younger people, unlike the pattern for seasonal flu.
CDC: Centers for Disease Control and Prevention
11/14/2014
Influenza Complications
11


Most people who get influenza will recover in a
few days to less than two weeks, but some people
will develop complications (such as pneumonia)
as a result of the flu, some of which can be lifethreatening and result in death.
Pneumonia, bronchitis, sinus and ear infections
are examples of complications from flu. The flu
can make chronic health problems worse. For
example, people with asthma may experience
asthma attacks while they have the flu, and
people with chronic congestive heart failure may
experience worsening of this condition that is
triggered by the flu.
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CDC: Centers for Disease Control and Prevention
Influenza Vaccine 2014-2015
12


Flu vaccines are designed to protect against the main flu
viruses that research suggests will be the most common
during the upcoming season. Three kinds of flu viruses
commonly circulate among people today: Influenza A (H1N1)
viruses, influenza A (H3N2) viruses, and influenza B viruses.
All of the 2014-2015 influenza vaccine is made to protect
against the following three viruses:





an A/California/7/2009 (H1N1)pdm09-like virus
an A/Texas/50/2012 (H3N2)-like virus
a B/Massachusetts/2/2012-like virus.
Some of the 2014-2015 flu vaccine also protects against an
additional B virus (B/Brisbane/60/2008-like virus).
Vaccines that give protection against three viruses are called
trivalent vaccines. Vaccines that give protection against four
viruses are called quadrivalent vaccines.
CDC: Centers for Disease Control and Prevention
2014
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Influenza Vaccine 2014-2015
13
Inactivated and recombinant flu vaccines
 You are getting an injectable flu vaccine, which
is either an "inactivated" or "recombinant"
vaccine. These vaccines do not contain any
live influenza virus. They are given by
injection with a needle, and often called the
"flu shot."
 A different, live, attenuated (weakened)
influenza vaccine is sprayed into the nostrils.
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CDC: Centers for Disease Control and Prevention 2014
Influenza Vaccine 2014-2015
14








How does Fluzone High-Dose differ from other flu vaccines?
Fluzone High-Dose is an injected flu vaccine formulated for people age 65 years and older. Like
other flu vaccines, Fluzone High-Dose is made up of the three flu strains most likely to cause the
flu during the upcoming season. The high-dose vaccine, however, contains four times as much flu
virus antigen — the part of the vaccine that stimulates the immune system — as regular Fluzone
and other standard flu vaccines.
Why is it needed?
In response to a regular flu shot, older people produce 50 to 75 percent fewer antibodies, which
protect against the vaccine antigens, than do younger adults.
Evidence that a high-dose flu vaccine can compensate for this difference originally comes from
studies that found higher post-vaccine antibody levels in older people who received high-dose flu
vaccine than in those who received standard flu vaccine.
In addition, one study found almost 25 percent fewer cases of proven influenza in adults age 65
and older who took the high-dose vaccine compared with those who took the standard-dose
vaccine.
Are there side effects?
In the largest of three clinical studies comparing high-dose and standard-dose flu vaccine, those
who received the high-dose vaccine were more likely to develop side effects, such as fever and
soreness at the injection site, during the week after vaccination.
James M. Steckelberg, M.D.
www.mayoclinic.org/diseases-conditions/flu/expertanswers/fluzone/faq-20058032
11/14/2014
Influenza Vaccine 2014-2015
15
Are there new recommendations for the 2014-2015 influenza
season?

Starting in 2014-2015, CDC recommends use of the nasal spray
vaccine (LAIV) for healthy* children 2 through 8 years of age, when
it is immediately available and if the child has no contraindications
or precautions to that vaccine.

Recent studies suggest that the nasal spray flu vaccine may work
better than the flu shot in younger children. However, if the nasal
spray vaccine is not immediately available and the flu shot is,
children 2 years through 8 years old should get the flu shot. Don’t
delay vaccination to find the nasal spray flu vaccine.

It takes about two weeks after vaccination for antibodies to develop
in the body and provide protection against the flu.
CDC: Centers for Disease Control and Prevention
2014
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Influenza Vaccine 2014-2015
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Can I get vaccinated and still get the flu?

Yes. It’s possible to get sick with the flu even if you have been vaccinated.
This is possible for the following reasons:

You may be exposed to a flu virus shortly before getting vaccinated or
during the period that it takes the body to gain protection after getting
vaccinated. This exposure may result in you becoming ill with flu before the
vaccine begins to protect you. (About 2 weeks after vaccination, antibodies
that provide protection develop in the body.)

You may be exposed to a flu virus that is not included in the seasonal flu
vaccine. There are many different flu viruses that circulate every year. The
flu vaccine is made to protect against the three or four flu viruses that
research suggests will be most common.

Unfortunately, some people can become infected with a flu virus the flu
vaccine is designed to protect against, despite getting vaccinated.
Protection provided by flu vaccination can vary widely, based in part on
health and age factors of the person getting vaccinated. In general, the flu
vaccine works best among healthy younger adults and older children.
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Some older people and people with certain chronic illnesses may develop
less immunity after vaccination. Flu vaccination is not a perfect tool, but it is
Influenza Vaccine 2014-2015
17
How much flu vaccine will be available this season?
 As of mid-October, seven influenza vaccine
manufacturers are projecting that as many as 151
million to 156 million doses of influenza vaccine
will be available for use in the United States
during the 2014-2015 influenza season.
How much of the flu vaccines for the United States
during 2014-2015 will be quadrivalent?
 Of the 151 million to 156 million doses of influenza
vaccine projected to be available for the 20142015 season, manufacturers estimate that 76
million doses will be quadrivalent flu vaccine.
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CDC: Centers for Disease Control and Prevention
Influenza Antiviral Medications.
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




Influenza antiviral prescription drugs can be used to treat influenza or to
prevent influenza.
Four licensed prescription influenza antiviral agents are available in the
United States.
Two FDA-approved influenza antiviral medications are recommended for
use in the United States during the 2013-2014 influenza season: oral
oseltamivir (Tamiflu®) and inhaled zanamivir (Relenza®). Oseltamivir
and zanamivir are chemically related antiviral medications known as
neuraminidase inhibitors that have activity against both influenza A and B
viruses.
Amantadine and rimantadine are antiviral drugs in a class of medications
known as adamantanes. These medications are active against influenza A
viruses, but not influenza B viruses. As in recent past seasons, there is a
high prevalence (>99%) of influenza A(H3N2) and influenza
A(H1N1)pdm09 (2009 H1N1) viruses resistant to adamantanes. Therefore,
amantadine and rimantadine are not recommended for antiviral treatment
or chemoprophylaxis of currently circulating influenza A viruses.
Antiviral resistance to oseltamivir and zanamivir among circulating influenza
viruses is currently low, but this might change. Also, antiviral resistance can
emerge during or after treatment in certain patients (e.g.,
immunosuppressed).
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CDC: Centers for Disease Control and Prevention 2014
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ABOUT
ENTEROVIRUS
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Enterovirus
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
Non-enveloped, spherical, about 30 nm in diameter, T=pseudo3 icosahedral
capsid surrounding the naked RNA genome.
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Enterovirus 2014
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
General Key Points About Enteroviruses and Enterovirus D68

Enteroviruses are very common viruses; there are more than 100 types.
It is estimated that 10 to 15 million enterovirus infections occur in the United
States each year. Tens of thousands of people are hospitalized each year
for illnesses caused by enteroviruses.
Enteroviruses can cause respiratory illness, febrile rash, and neurologic
illnesses, such as aseptic meningitis (swelling of the tissue covering the
brain and spinal cord), encephalitis (swelling of the brain) and acute flaccid
paralysis
Most infected people have no symptoms or only mild symptoms, but some
infections can be serious.
Infants, children, and teenagers are most likely to get infected with
enteroviruses and become sick. Adults can get infected with enteroviruses,
but they are more likely to have no symptoms or mild symptoms.
In general, the spread of enteroviruses is often quite unpredictable, and
different types of enteroviruses can be common in different years with no
particular pattern. In the United States, people are more likely to get
infected with enteroviruses in the summer and fall.
From California Department of Public Health and Sara H. Cody,
11/14/2014
MD Health Officer, Santa Clara County Public Health Department
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Enterovirus
22

Activity of Enterovirus D68-like Illness in
States
Activity October 26-November 1, 2014.
CDC: Centers for Disease Control and Prevention 2014
11/14/2014
Enterovirus 2014
23

From mid-August to October 2, 2014, more than 500 people in 43 states and the District of Columbia were
confirmed to have respiratory illness caused by EV-D68. The cases were confirmed by CDC or state public health
labs that notified CDC. So far, CDC has found four patients who have tested positive for EV-D68 and have died
nationwide. CDC and state health departments are investigating whether EV-D68 was a cause of death in these
cases.

Testing has primarily been done in children with severe respiratory illness. However, it is likely that EV-D68 is
circulating widely.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We are
currently in the middle of the enterovirus season. EV-D68 infections are likely to decline later in the fall.

Many other viruses that cause respiratory illness are circulating in the United States during this time of year. Not
all clusters or outbreaks of respiratory illness occurring now are due to EV-D68.

EV-D68 is not a new type of enterovirus. It is genetically very close to the types of EV-D68 that were previously
detected in 2012 and 2013 in the United States, southern Europe, and Asia.

The general public can help protect themselves from respiratory illnesses by washing hands with soap and water,
avoiding close contact with sick people, and disinfecting frequently touched surfaces.
From California Department of Public Health and Sara H. Cody, MD Health
Officer, Santa Clara County Public Health Department
11/14/2014
24
ABOUT NOROVIRUS
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Norovirus
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

X-ray crystallographic structure of the Norwalk virus
capsid
The virus particles demonstrate an amorphous
surface structure when visualized usingelectron
microscopy and are between 27-38 nm in size.
Prasad BV, Crawford S, Lawton JA, Pesavento J, Hardy M, Estes MK (2001). "Structural studies on gastroenteritis
viruses". Novartis Found. Symp. Novartis Foundation Symposia 238: 26–37; discussion 37–46.
doi:10.1002/0470846534.ch3. ISBN 978-0-470-84653-7. PMID 11444031.
Norovirus
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Norovirus
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
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
Norovirus Has Many Names. You may hear norovirus illness called "food
poisoning" or "stomach flu." Food poisoning can be caused by noroviruses.
But, other germs and chemicals can also cause food poisoning.
Norovirus illness is not related to the flu (influenza), which is a respiratory
illness caused by influenza virus.
Norovirus is a very contagious virus. You can get norovirus from an infected
person, contaminated food or water, or by touching contaminated surfaces.
The virus causes your stomach or intestines or both to get inflamed (acute
gastroenteritis). This leads you to have stomach pain, nausea, and diarrhea
and to throw up.
Anyone can be infected with norovirus and get sick. Also, you can have
norovirus illness many times in your life. Norovirus illness can be serious,
especially for young children and older adults.
Norovirus is the most common cause of acute gastroenteritis in the United
States. Each year, it causes 19-21 million illnesses and contributes to
56,000-71,000 hospitalizations and 570-800 deaths. Norovirus is also the
most common cause of foodborne-disease outbreaks in the United States.
The best way to help prevent norovirus is to practice proper hand washing
and general cleanliness.
CDC: Centers for Disease Control and Prevention
2014
11/14/2014
Norovirus
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



Norovirus is a highly contagious virus. Anyone can get infected with
norovirus and get sick. Also, you can get norovirus illness many
times in your life. One reason for this is that there are many different
types of noroviruses. Being infected with one type of norovirus may
not protect you against other types.
Norovirus can be found in your stool (feces) even before you start
feeling sick. The virus can stay in your stool for 2 weeks or more
after you feel better.
You are most contagious when you are sick with norovirus illness,
and during the first few days after you recover from norovirus
illness.
You can become infected with norovirus by accidentally getting
stool or vomit from infected people in your mouth. This usually
happens by



eating food or drinking liquids that are contaminated with norovirus,
touching surfaces or objects contaminated with norovirus then putting
your fingers in your mouth, or
having contact with someone who is infected with norovirus (for
example, caring for or sharing food or eating utensils with someone with
norovirus illness).
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CDC: Centers for Disease Control and Prevention 2014
Norovirus
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Norovirus and food
 Norovirus is the leading cause of illness and outbreaks from
contaminated food in the United States. Most of these outbreaks
occur in the food service settings like restaurants. Infected food
workers are frequently the source of the outbreaks, often by
touching ready-to-eat foods, such as raw fruits and vegetables,
with their bare hands before serving them. However, any food
served raw or handled after being cooked can get contaminated
with norovirus.

Norovirus outbreaks can also occur from foods, such as oysters,
fruits, and vegetables, that are contaminated at their source.

Norovirus can spread quickly in closed places like daycare
centers, nursing homes, schools, and cruise ships. Most
norovirus outbreaks happen from November to April in the
United States.
CDC: Centers for Disease Control and Prevention 2014
11/14/2014
ABOUT EBOLA
© 2014 Santa Clara County Public Health Department
The Public Health Department is owned and operated by the County of Santa Clara
32
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Background



Ebola was first identified in a remote area of
Africa in 1976.
Since then, outbreaks have happened now
and again in Africa.
Before the current outbreak could be brought
under control, it made it into urban areas.
Cases of Ebola Virus Disease in Africa, 1976 2014
34
Page last updated: November 7, 2014
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Cases of Ebola Virus Disease in Africa, 1976 - 2014
35

Country
Town
Cases

Multiple countries multiple

Uganda

Dem. Rep. of Congo Isiro Health Zone
2012

Uganda
Kibaale District
11*
4*
Sudan ebolavirus
2012

Uganda
Luwero District
1
1
Sudan ebolavirus
2011

Dem. Rep. of Congo Luebo

Uganda

13241
Luwero District
6*
Deaths
4950
Year
Zaire ebolavirus
3*
Sudan ebolavirus
36*
32
Bundibugyo
Species
13*
15
2014
2012
Bundibugyo ebolavirus
Zaire ebolavirus
2008
149
37
Bundibugyo ebolavirus 2007
Dem. Rep. of Congo Luebo
264
187
Zaire ebolavirus

South Sudan Yambio
17
7
Zaire ebolavirus

Republic of Congo
Mbomo
35
29

Republic of Congo Mbomo
143
128

Republic of Congo
57

Gabon
Libreville
65
53
Zaire ebolavirus
2001

Uganda
Gulu
425
224
Zaire ebolavirus
2000

South Africa
Johannesburg
2
1
Zaire ebolavirus
1996

Gabon
Booue
60
45
Zaire ebolavirus
1996

Gabon
Mayibout
37
21
Zaire ebolavirus
1996

Dem. Rep. of Congo Kikwit

Côte d'Ivoire (Ivory Coast)

Gabon

South Sudan Nzara

Dem. Rep. of Congo Tandala


Not specified
315
Mekouka
52
2004
Zaire ebolavirus
Zaire ebolavirus
43
2003
2002
Zaire ebolavirus
250
Tai Forest
2007
2001
Zaire ebolavirus
1
1995
0
Taï Forest ebolavirus
31
Zaire ebolavirus
1994
34
22
Sudan ebolavirus
1979
1
1
Zaire ebolavirus
South Sudan Nzara
284
151
Sudan ebolavirus
Dem. Rep. of Congo Yambuku
318
280
Zaire ebolavirus
1994
1977
1976
1976
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Background


The current outbreak started in Guinea, midMarch, 2014.
Then spread to Liberia, Sierra Leone and
Nigeria.
 Nigeria
now free of the virus.
 Mali and Senegal have imported cases without
transmission.
 Spain and U.S. have imported cases with
transmission.

This is the largest Ebola Virus Disease
outbreak to date. Currently there are more
cases than all other previous outbreaks
37
Ebola Outbreak Currently in 3 Countries in West
Africa
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BOLA RESPONSE SITUATION REPORT
38

World Health Organization

EBOLA RESPONSE ROAD MAP SITUATION REPORT UPDATE

7 NOVEMBER 2014

HIGHLIGHTS

There have been 13,268 reported Ebola cases in eight affected countries since the outbreak began, with 4960
reported deaths.

Case incidence is declining in some districts in Guinea, Liberia and Sierra Leone, while steep rises persist in
other districts.

Intense transmission in the three most affected countries demands widespread rigorous control measures.
Preparedness in unaffected neighbouring countries is also critical.

There have been no new cases in Mali, Spain and the USA, but a high level of vigilance is essential in these
countries.

CASES / DEATHS

Guinea 1760 / 1054

Liberia 6619 / 2766

Sierra Leone 4862 / 1130

Mali 1 / 1

Nigeria 20 / 8

Senegal 1 / 0

Spain 1 / 0

United States of America 4 / 1

Total
13268 / 4960
http://apps.who.int/iris/bitstream/10665/137592/1
roadmapsitrep_7Nov2014_eng.pdf
11/14/2014
Many countries in Africa are farther from the outbreak than countries
in Europe
39
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What is Ebola?
40



It is a rare and deadly disease caused by one of
the Ebola virus strains, which are found in
several African countries.
Based on evidence and the nature of similar
viruses, researchers believe that the virus is
started in animal and bats are the most likely
source.
Ebola can cause disease in humans and
primates.
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How does Ebola spread?
41



Animal (bats, primates) to human.
Human to human: through direct contact with
blood or body fluids (saliva, mucus, vomit, pee
and poop), and then touching eyes, nose,
mouth or a wound or cut.
Common settings for transmission:
 Healthcare
workers taking care of sick;
 Home caregivers taking care of sick;
 Traditional funerals that involve touching the
body.
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42
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When does Ebola spread?
43
The incubation period for Ebola is the time from being exposed to the disease and beginning of
symptoms.
Incubation for
Ebola ranges
from 2 to 21 days,
but 8 – 10 days is
typical.
Exposed/No Symptoms: Not
infectious and no risk to the
public’s health.
Early Symptoms: Low risk for
transmitting disease to others.
As the symptoms
get worse, the
patient is more
infectious.
Symptoms Worsen: High risk for
transmitting to others.
After Death: Risk of transmission
remains high.
Who may have Ebola?



Have they been in
Guinea, Liberia or
Sierra Leone in the
last 21 days?
Have they been
exposed to a person
with Ebola?
Are they ill with
symptoms that might
indicate Ebola?
Ebola Symptoms
45

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

Starts with common symptoms: Fever (87%),
chills, muscle aches (39%), weakness (76%).
Day 4 of illness: Severe watery diarrhea (65%),
nausea, vomiting (67%), abdominal pain (44%),
chest pain, shortness of breath, profound
weakness.
Day 5 – 7 of illness: May develop rash.
Day 6 – 16: Multi-organ failure, septic shock,
bleeding (18%).
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Treatment Of Ebola
No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola.
Symptoms of Ebola and complications are treated as they appear. The following
basic
interventions, when used early, can significantly improve the chances of survival:
• Providing intravenous fluids (IV) and balancing electrolytes (body salts).
• Maintaining oxygen status and blood pressure.
• Treating other infections if they occur.
Experimental vaccines and treatments for Ebola are under development, but they
have not
yet been fully tested for safety or effectiveness.
Recovery from Ebola depends on good supportive care and the patient’s immune
response.
People who recover from Ebola infection develop antibodies that last for at least 10
years,
possibly longer.
It is not known if people who recover are immune for life or if they can become
Treatment of Ebola
Among patients from West Africa, large volumes of intravenous fluids have often been
required to correct dehydration due to diarrhea and vomiting.
Several investigational therapeutics for Ebola virus disease are in development. There are no
approved vaccines available for EVD. Several investigational Ebola vaccines are in
development, and Phase I trials are underway for some vaccine candidates.
Source: Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html
Treatment Centers
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Ebola African Community Information
49
From Ministry of Health, and Sanitation, Sierra Leone Used with permission.
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Ebola African Community Information
50
From Ministry of Health, Liberia - Used with
permission.
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Ebola African Community Information
51
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Ebola African Community Information
52
From Ministry of Health, Liberia - Used with
permission.
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Ebola African Community Information
53
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Ebola African Community Information
54

How to make chlorine solutions from 5% liquid
bleach
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Ebola Community Information
55
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Public Health Preparedness
56
Objective #1: Preparing the Health Care
System

Safe identification and care of a
potential Ebola patient includes:
Rapid ID of patient in all healthcare
settings.
 Rapid implementation of infection
control precautions.
 Safe transport of ill patient to
hospital via Emergency Medical
Services Agency.
 Identification and support of referral
hospitals for ongoing care.
 Effective decontamination of
equipment, vehicles and facilities.

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Public Health Preparedness
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Objective #2: Educating the
Public
 Clear, concise, consistent risk
communication with public,
partners and other
stakeholders.
 Staying up-to-date and in
communication with California
Department of Public Health &
the Centers for Disease
Control
and Prevention (CDC).
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Public Health Preparedness
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Objective #3: Ensuring public health system
is ready to respond
 Rapid identification, risk
assessment and
implementation of public
health actions for any
contacts to a confirmed
Ebola case to stop the chain
of transmission.
 Protocols in place for followup with recent travelers from
affected countries.
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Know the Facts
60



There is no Ebola in Santa Clara County or
California.
Ebola can only be spread by direct contact
with blood or body fluids of a person who is
sick with symptoms of the disease.
Systems are in place for a quick response
from the Public Health Department and
medical community to keep the public safe.
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Is it Flu or Ebola?
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Flu (influenza)

The flu is a common contagious respiratory illness caused by flu viruses. The flu is different from a cold. Flu can cause mild to severe illness, and complications can lead to death.
Ebola

Ebola is a rare and deadly disease caused by infection with an Ebola virus.
How Flu Germs Are Spread
How Ebola Germs are Spread

The flu is spread mainly by droplets made when people who have flu cough, sneeze, or talk. Viruses can also spread on surfaces, but this is less common. People with flu can spread the
virus before and during their illness.

Ebola can only be spread by direct contact with blood or body fluids from a person who is sick or who has died of Ebola or Objects like needles that have been in contact with the blood or body
fluids of a person sick with Ebola. Ebola cannot spread in the air or by water or food.
Who Gets The Flu?
Who Gets Ebola?

Anyone can get the flu. Some people—like very young children, older adults, and people with some health conditions—are at high risk of serious complications.

People most at risk of getting Ebola are

Healthcare providers taking care of Ebola patients.

Friends and family who have had unprotected direct contact with blood or body fluids of a person sick with Ebola.
Signs and Symptoms of Flu

The signs and symptoms of flu usually develop within 2 days after exposure. Symptoms come on quickly and all

• Fever or feeling feverish
• Headache
• Muscle or body aches
• Feeling very tired (fatigue)

• Sore throat
• Runny or stuffy nose

Cough
Signs and Symptoms of Ebola

The signs and symptoms of Ebola can appear 2 to 21 days after exposure. The average time is 8 to 10 days. Symptoms of Ebola develop over several days and become progressively more
severe.

• People with Ebola cannot spread the virus until symptoms appear.

Fever

Severe headache

Muscle pain

Feeling very tired (fatigue)

Vomiting and diarrhea develop after 3–6 days

Weakness (can be severe) Stomach pain

Unexplained bleeding or bruising
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
For more information about the flu and Ebola, visit www.cdc.gov/flu and www.cdc.gov/ebola.
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Questions?
California Hotline
855-421-5921
8:00 a.m. to 5:00 p.m. Monday through Friday
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