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Training on the Ebola Virus Disease (duration 3 days) Efficient by Edification – EFFO Ebola 01.08.2016 Training structure Safety and good quality work EFFO Ebola Module 1: Knowledge about Ebola Virus Disease Module 2: Module 3: Module 4: Module 5: Module 6: Community response Standard precautions Triage & isolation Personal protective equipment Water, disinfection and cleaning Support from the community Support from the hospital administration Support from the population 01.08.2016 Ebola virus disease Module 1 (Part 1) 01.08.2016 Learning objectives module 1 (part 1) General objectives To know general information on Ebola virus disease and to be motivated to practice to gain more confidence and skills when dealing with suspected Ebola patients. Specific objectives To know following information about the Ebola virus disease : 1. 2. 3. 4. 5. Epidemiology of the outbreak 2013-2016 Modes of contamination and transmission of Ebola virus Incubation period Symptoms Differential diagnosis 01.08.2016 Presentation outline Module 1 Part 1 Part 2 -now- -later- 1. Epidemiology 2. Information about the Ebola virus 3. Transmission and incubation period 4. Symptomatology 5. Differential diagnosis 01.08.2016 1. Laboratory diagnosis: PCR, rapid tests 2. Pathophysiology 3. Care of cases 4. Work in the isolation area and the stress caused Ebola virus outbreaks in Africa since 1976 Source: CDC 01.08.2016 2014: An extraordinary situation New situation: • Very high number of cases • Several countries affected • Failure of conventional measures to control the epidemic 1976 602 cases and 431 deaths in Sudan and DR Congo 01.08.2016 1995 2000 West Africa 2013-2016 2002 2007 Several less serious epidemics in Congo, Uganda, DR Congo with > 100 cases 2013-2016 Over 28 600 cases and over 11 300 deaths Ebola has affected other countries The most affected regions : Guinea, Liberia and Sierra Leone Ebola spread to other countries 36 cases in 7 other countries • • • • • • • 01.08.2016 Italy Mali Nigeria Senegal Spain UK United States The problem: Ebola can destroy health structures → “ordinary” patients no longer receive treatment These were isolated events; the transmission was stopped. Health workers at risk “The patient scares me…?!” • More than 800 health workers were infected more than 500 died. You can protect yourself! You must know HOW to and train it. • Health workers are key persons in the fight against Ebola! 01.08.2016 Information about the Ebola virus (I) “Ebola” is the name of a river in northern Zaire, close to where the virus has been discovered in 1976. • The Ebola virus belongs to the family of Filoviridae, genus: Filovirus • There are five species: Zaire ebolavirus Sudan ebolavirus Bundibugyo ebolavirus Taï Forest ebolavirus Reston ebolavirus (macaques) Ebolavirus: electron-microscopical picture Source: CDC/ Cynthia Goldsmith 01.08.2016 Information about the Ebola virus (II) The ebolavirus has an envelope. Enveloped viruses can be destroyed by: • Chlorine solution • heat (1 h 60°C) • UV-rays (sunlight) • Detergents (soap) Several methods are combined for greater safety. more information in Module 6 01.08.2016 Structure of ebolavirus Source: Feldmann, N Engl J Med 2014 The Ebola virus in humans and animals Source: RKI 1. Reservoir of the virus: probably fruit bats and bats 01.08.2016 2. Epizootic in primates and other mammals 3. Primary infection in humans 4. Secondary transmission by direct or indirect contact Incubation period of the Ebola virus disease The incubation period is the time between infection and the appearance of the first symptoms of a disease. The incubation period is individual and depends, for example, on the amount of infectious agents and the immune system. In the case of Ebola: • No symptoms no risk of transmission • Incubation period: 2 to 21 days, mostly 11-12 days 01.08.2016 Modes of transmission The virus is highly contagious! It is transmitted by infected body fluids , through damaged skin, mucosa (e.g. eyes, nose, mouth) and parenterally through CONTACT with: • blood • vomit • stool • breast milk • saliva • tears • sweat • semen • urine 01.08.2016 Mode of transmission (how?) The disease is highly contagious! It is transmitted by infected blood or body fluids through direct or indirect contact: • direct contact with sick or deceased persons • during care at home or in hospital • certain burial practices • contact with clothing, bed sheets, or other objects contaminated with a patient`s fluids • The more the person is sick, the higher the risk of transmission 01.08.2016 The initial symptoms of EVD • Fever • Nausea • Headache • Vomiting • Muscle pain • Diarrhea • Intense weakness • Abdominal pain • Loss of appetite • Rash The clinical symptoms of EVD differ individually. The symptoms are typical but not specific. 01.08.2016 The different phases of EVD __________________________________________________________________ Phase of Time since Clinical features illness Symptom Onset ______________________________________________________________________________________________________________________________________________________________________ Early febrile 0-3 days Fever, malaise, fatigue, body aches Gastrointestinal 3-10 days Primary: epigastric pain, nausea, vomiting, diarrhea Associated: persistent fever, asthenia, headache, conjunctival injection, chest pain, abdominal pain, arthralgia, myalgia, hiccups, delirium Shock or recovery 7-12 days Shock: diminished consciousness or coma, rapid thready pulse, oliguria, anuria, tachypnea Recovery: resolution of gastrointestinal symptoms, increased oral intake, increased energy Late ≥ 10 days Gastrointestinal haemorrhage, secondary infections, meningocomplications encephalitis, persistent neurocognitive abnormalities ___________________________________________________________________________________ (According to Chertow et al., 2014) 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Which symptom is this? Source: CDC 01.08.2016 Differential diagnosis These symptoms are common with other diseases: • malaria • plague • typhoid fever • leptospirosis • meningococcal disease • rickettsiosis • shigellosis • Relapsing fever • cholera • Other viral haemorrhagic fevers (e.g. Yellow fever, Lassa fever, Dengue fever, Crimean-Congo haemorrhagic fever) • hepatitis • viral influenza 01.08.2016 How to prevent transmission? What you should know… What you should do… Direct or indirect contact without protection can be very dangerous Use personal protective equipment (PPE) The Ebolavirus is not spread by air like, e.g. measles A distance of two metres is sufficient for protection No symptoms no risk for transmission 01.08.2016 WATCH OUT FOR THE EXCEPTION! Possible transmission after clinical recovery through sexual contact (semen) Ebola remains endemic The Ebola virus epidemic in West Africa 2013-2016 Total number of cases: 28 616 Cases of death: 11 310 The risk for new EVD outbreaks will remain: • There are always suspected cases for new EVD. • Animal Reservoir? (fruit bats or bats) • Exposition to infected body fluids of survivors is possible, but the risk of EVD transmission through casual or household contact is very low. • Crucial Importance of long-term follow-up for survivors! 01.08.2016 The correct use of PPE is important! Train the use of each PPE element! Some of the difficult elements are : Hood Goggles Mask Gloves (removal) Source: RKI 01.08.2016 Thank you for your attention! Copyright Abbildungen © leremy – Fotolia.com 01.08.2016