Download Module 1

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
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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
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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
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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
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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
•
•
•
•
•
•
•
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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!
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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
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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
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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
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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
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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
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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
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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.
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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)
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Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
01.08.2016
Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
01.08.2016
Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
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Which symptom is this?
Source: CDC
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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
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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
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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!
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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!
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© leremy – Fotolia.com
01.08.2016