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Ebola Virus The Clinical Excellence Commission November 2014 What is a Filovirus • Family called Filoviridae - cause severe haemorrhagic fever in humans and nonhuman primates. • Two members of this virus family: Marburg virus and Ebola virus. • Four species of Ebola virus: Ivory Coast, Sudan, Zaire, and Reston. • Ebola-Reston does not cause severe disease in humans; however, it can be fatal in monkeys. 2 What is a Filovirus • Filovirus virions (complete viral particles) may appear in several shapes - include long, branched filaments as well as shorter filaments shaped like a "6", a "U", or a circle. • Viral filaments are enveloped in a lipid (fatty) membrane. • Each virion contains one molecule of singlestranded, negative-sense RNA. 3 What is a Filovirus 4 The History of Filoviruses • The first filovirus was recognized in 1967 when a number of laboratory workers in Germany and Yugoslavia, who were handling tissues from green monkeys, developed haemorrhagic fever. • A total of 31 cases and seven deaths were associated with these outbreaks. The virus was named after Marburg, Germany, the site of one of the outbreaks. 5 The History of Filoviruses • Ebola virus first identified in 1976 in northern Zaire (Democratic Republic of Congo) and southern Sudan. • The outbreaks involved what eventually proved to be two different species of Ebola virus; both were named after the nations in which they were discovered. • Both viruses showed themselves to be highly lethal, as 90% of the Zairian cases and 50% of the Sudanese cases resulted in death. 6 Spread • Just how the virus is transmitted from the natural reservoir to a human is unknown. • Hard to catch - Human to human transmission through direct contact with body fluids and indirect contact through body fluids such as unsterilized equipment. • Entry points – mucous membranes, cuts & abrasions • Easy to catch – infective dose 1-6 virus particles • Importance of Personal Protective Equipment (PPE) • Not infectious before symptoms Viral Haemorrhagic Fevers Virus Lassa Ebola Marburg Crimean-Congo • • • • Incubation period 6 – 21 days 6 - 21 days (8 – 10 days) 3 – 10 days 1 – 12 days Fever and malaise Vomiting and diarrhoea Bruising, rashes and bleeding High case fatality rates Presenting Symptoms (2) • Starts with sudden onset fever, malaise, myalgia & headache • Pharyngitis, vomiting, diarrhoea and maculopapular rash • Haemorrhage & shock in 2nd week • (50% no haemorrhagic manifestations) • Death 6 – 16 days after onset 13 Presenting symptoms (44/106) Symptom Fever Headache Weakness Dizziness Diarrhoea Abdominal pain Sore throat Vomiting Conjuctivitis Percentage 89% 80% 66% 60% 51% 40% 34% 34% 31% 14 Symptoms associated with death • • • • 44 patients Weakness Dizziness Diarrhoea (P = 0.003) (P = 0.01) (P = 0.04) • Diarrhoea on presentation had 94% mortality rate compared with 65% for no diarrhoea • Only one patient had haemorrhagic features 15 Fatal cases 16 Fatal symptoms on presentation Pathogenesis West African Outbreak 2014 - CDC 2014 Outbreak • Countries : Guinea, Sierra Leone, Liberia, and Mali (new). Nigeria & Senegal(now clear) • Cases as at 2/11/14 • Cases – 13042 • Deaths – 4818 (~37% case fatality rate) • Also in USA, Spain, - infected in West Africa or while caring for patients • Democratic Republic of Congo - unrelated Putting into Perspective 21 Treatment • Supportive • Fluids, blood, symptom management • ICU • Vaccine • difficult due to mutations • Canadians success in 4 monkeys • Drugs • Some experimental - ZMapp Prevention Spread in West Africa – Larger populations than previous outbreaks – More communications and movement – 10 year civil war in Sierra Leone – refugees – Poor medical infrastructure – distrust of Western medicine – Malnutrition – Access to clean water and sanitation – Local customs – burial practices Prevention (2) Identify possible infected persons – Airport temp. screening – not effective – Algorithm Ebola – NSW Roles • NSW Ministry of Health - Health Protection Unit are the lead agency. • PHUs provide advice and support to facilites. • CEC support role – advice • • • • Infection prevention and control in hospitals PPE Environmental Cleaning Waste management 25 NSW CONTINGENCY PLAN FOR VIRAL HAEMORRHAGIC FEVERS Health Protection NSW Email: [email protected] Phone: (02) 9391 9195 Last updated 22 October 2014 http://www.health.nsw.gov.au/Infectious/alerts/Do cuments/NSW-VHF-Plan-Web.pdf Prevention (3) • Isolation of infected persons – quarantine • New Act in NSW – reportable by MO • Quarantine • Disinfection of contaminated surfaces – bleach • Personal Protective Equipment (PPE) • VHF isolation precautions is currently the centerpiece of control. Future of Ebola outbreak • Outbreak uncontrolled • If not controlled - millions of infected individuals • Australia – from overseas, PPE breakdown • Mutation • Airborne virus – highly unlikey to change mode of transmission • Decreased severity – more problematic ??? • Other potential strains 29 Thank you Questions For further information: http://www.health.nsw.gov.au/infectious/alerts/pages/EVD.aspx www.cec.health.nsw.gov.au 30