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Ebola Submitted by Jeannie M. Yocum, CHUC of Fresno, California Learning Objectives: 1. List three subtypes of Ebola that cause disease in humans. 2. List at least three symptoms of Ebola. 3. Describe the treatment plan for Ebola. Ebola hemorrhagic fever (also just called Ebola) is a potentially fatal, highly contagious illness caused by the Ebola virus which is one of two members of a family of ribonucleic acid (RNA) viruses called Filoviridae. There are four identified subtypes of the virus. Three of the four have caused disease in humans: Ebola-Zaire Ebola-Sudan Ebola-Ivory Coast The fourth subtype, Ebola-Reston, has caused disease in nonhuman primates, but not in humans. The Makona strain of Ebola virus that caused the outbreak in West Africa, killing more than 11,000 people and sickening even more, is apparently less virulent than the Mayinga strain isolated in Central Africa in 1976, according to a study of macaque monkeys published on June 9, 2015 in the U.S. Centers of Disease Control and Prevention (CDC). Ebola is often fatal in humans and nonhuman primates (monkeys, gorillas and chimpanzees). The virus was first recognized in the Democratic Republic of the Congo (formerly Zaire), and it has appeared sporadically since 1976. The exact origin, locations and natural habitat (known as the natural reservoir) of the virus remain unknown; however, on the basis of available evidence and the nature of similar viruses, researchers believe that the Ebola virus lives in an animal host that is native to the African continent. They continue to search for the exact animal. Just as scientists are unsure of the animal host for the virus, they are also unsure how an outbreak occurs. Researchers have hypothesized that the first patient with Ebola becomes infected with the virus through contact with an infected animal. Once the virus infects the first human, transmission of Ebola continues through direct contact with an infected person or his or her body fluids (such as blood or secretions). The spread of the virus from an infected person most often occurs during the late stages of an infection. When a person becomes infected with Ebola virus, the virus begins to multiply within the body. After four to six days, on average, symptoms can begin. The period between infection with the virus and the start of symptoms is called the incubation period. The incubation period for Ebola can be as short as two days or as long as 21 days. There are several common symptoms of Ebola, such as fever, sore throat, weakness, severe headache, joint and muscle aches, diarrhea, vomiting, dehydration, dry/hacking cough, stomach pain, internal bleeding, external bleeding, rash and hiccups. Sometimes the skin rash is not recognized until the rash begins to peel. In pregnant women, miscarriage and heavy bleeding are common Ebola symptoms. In order to make a diagnosis, the doctor will ask a number of questions and perform a physical exam. If the doctor suspects an Ebola virus infection, he or she will order lab tests that can identify either the virus itself or antibodies made by the body against the virus. The CDC states the following diagnostics tests are available: Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing IgM ELISA Polymerase chain reaction (PCR) Virus isolation Before making a diagnosis of Ebola, the doctor will also consider other conditions that can cause similar symptoms. Some of these conditions include: Influenza (the flu) Malaria (disease transmitted by an infected mosquito) Typhoid fever (disease transmitted by contaminated food or water) Other viral hemorrhagic fevers There is only one Ebola cure: time. There is currently no proven treatment that can kill the virus. Thus, treatment focuses on providing relief from symptoms as the body fights the virus. This is called supportive care. The CDC states 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. Death occurs in between 50 and 90 percent of Ebola cases. Research scientists do not understand why some people are able to recover from Ebola hemorrhagic fever and others are not; however, it is known that victims usually have not developed a significant immune response to the virus at the time of death. Confirmed cases of Ebola virus infections have been reported in the Democratic Republic of the Congo, the Ivory Coast, Gabon, Sudan, and Uganda. On September 30, 2014 the CDC confirmed the first laboratory-confirmed case of Ebola to be diagnosed in the United States in a man who had traveled to Dallas, Texas from Liberia. The man did not have symptoms when leaving Liberia, but developed symptoms approximately four days after arriving in the United States. After being admitted to the hospital the patient was isolated and specimens were sent to the CDC and to a Texas laboratory. Local public health officials identified all close contacts of the index patient for daily monitoring for 21 days after exposure. The patient passed away on October 8. By November 7 all contacts of the patient completed the 21-day monitoring period. The CDC recognizes that any case of Ebola diagnosed in the United States raises concerns, and any death is too many. Medical and public health professionals across the country have been preparing to respond to the possibility of additional cases. CDC and public health officials in Texas, Ohio and New York took precautions to identify people who had close personal contact with the patients, and healthcare professionals have been reminded to use meticulous infection control practices at all times. The CDC lists the following recommendations: 1. CDC recommends a combination of measures to prevent transmission of Ebola Virus Disease in hospitals including Personal Protective Equipment (PPE). These should be implemented in addition to routine practices that are implemented on a daily basis to prevent transmission of infectious diseases from patient to patient and patient to healthcare personnel. 2. Healthcare personnel might need to take additional infection control steps if a patient under investigation or patient with confirmed Ebola has other conditions or illnesses caused by specific infectious diseases, such as tuberculosis. 3. Healthcare personnel can be exposed to Ebola virus by touching a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (for example, the eyes, nose, or mouth) are particularly hazardous. Procedures that can increase environmental contamination with infectious material or create aerosols should be minimized. As stated in the national health unit coordinator certification exam content outline, the certified health unit coordinator should adhere to infection control standards and identify and correct potential hazards. For the CHUC, this may involve ordering PPE supplies and posting signage at the patient’s door to ensure appropriate and consistent use of PPE by all people entering the patient room. In the aftermath of the events of September and October 2001, there is heightened concern that the Ebola virus might be used as an agent of bioterrorism. The deliberate release of Ebola virus is now regarded as a possibility, and the United States is taking precautions to deal with this. The Centers for Disease Control and Prevention (CDC) calls the Ebola virus a Category A agent. Category A agents are believed to present the greatest potential threat for harming public health and have a moderate to high potential for large-scale dissemination (spread). The public is generally more aware of Category A agents, and broad-based public health preparedness efforts are necessary. Other Category A agents include: Anthrax Plague Tularemia Smallpox References http://www.ebola.emedtv.com/ebola-articles.html http://www.the-scientist.com/?articles.view/ar http://www.cdc.gov/vhf/ebola/outbreaks/2014-wes e-Learning QUIZ ID # Web-06-01-16 DEADLINE FOR SUBMISSION OF THIS QUESTIONNAIRE IS MAY 31, 2017. Subject: Ebola Submitted by: Jeannie M. Yocum, CHUC of Fresno, California Objective: To identify facts about Ebola. Resources: Accompanying article submitted by Jeannie M. Yocum, CHUC Instructions: After reading the article, please write your answers to the following questions on the answer sheet on the last page. 1. What is Ebola? a. A highly contagious disease caused by a bacteria found in Africa b. A non-contagious virus caused by contaminated drinking water. c. A potentially fatal, highly contagious viral illness. d. A virus that causes the same symptoms as the measles, mumps and rubella 2. Which of these is not a subtype of the Ebola virus? a. Ebola-Reston b. Ebola-Sudan c. Ebola-Superior d. Ebola-Zaire 3. Which of these statements about Ebola is false? a. The Makona strain of Ebola virus caused the death of 11,000 people. b. There is no cure. c. Treatment usually consists of providing supportive care while the body fights the infection. d. You can cure Ebola with light therapy. 4. Researchers have hypothesized that the first patient with Ebola became infected with the virus through contact with _________________. a. an infected animal. b. blood. c. secretions. d. urine. 5. When a person becomes infected with Ebola virus when do symptoms usually occur on average? a. 24 hours b. 4-6 days c. 10-14 days d. 1 month 6. Which one of these is not a common symptom of Ebola? a. Discolored nail beds b. Dry/hacking cough c. Fever d. Joint and muscle aches 7. What other conditions cause symptoms similar to Ebola? a. Anemia b. Appendicitis c. Typhoid fever d. All the above 8. Death from Ebola occurs in what percentage of cases? a. 10-30 percent b. 20-80 percent c. 40-60 percent d. 50-90 percent 9. Which statement is false? a. The Ebola virus was first recognized in the United States. b. There is currently no proven treatment that can kill the Ebola virus c. Treatment of Ebola focuses on providing relief from symptoms as the body fights the virus. d. Victims of Ebola usually have not developed a significant immune response to the virus at the time of death. 10. The Centers for Disease Control and Prevention (CDC) calls the Ebola virus a Category A agent. Which of the following is not a Category A agent? a. Anthrax b. Plague c. Rabies d. Small pox e-Learning QUIZ ID # Web-06-01-16 Ebola VALUE: 2 NAHUC CONTACT HOURS Fee: $5 (U.S. Dollars) for NAHUC members, $10 (U.S. Dollars) for non-members Do not send cash. Make check payable to: NAHUC. If overpayment is made, refunds will be issued in the form of NAHUC Buck certificates. Directions: Print this answer sheet, circle the most correct answer based on the article and mail the completed answer sheet, self-addressed self-stamped return envelope along with appropriate fee to: Linda Winslow 2502 Norwood St Marquette, MI 49855-1240 Only quizzes with at least 70% answered correctly will be awarded contact hours. Please allow up to 6-8 weeks for quizzes to be returned. DEADLINE FOR SUBMISSION OF THIS QUESTIONNAIRE IS MAY 31, 2017. Member #: ________Name: _______________________________________________ Phone number: ___________ Email address: _______________________________ 1. a b c d 2. a b c d 3. a b c d 4. a b c d 5. a b c d 6. a b c d 7. a b c d 8. a b c d 9. a b c d 10. a b c d