Transcript MYTHS AND REALITIES OF EBOLA VIRUS DISEASE

MYTHS AND REALITIES OF
EBOLA VIRUS DISEASE
Awareness and sensitization seminar
By
Faculty of Medicine
Kaduna State University
Presentation outline
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Introduction – Professor Elegba (Medical Microbiology)
Epidemiology – Dr. MA Kana (Community Medicine)
Treatment – Dr. H Bello-Manga (Haematology)
Prevention – Dr. F Adiri (Community Medicine)
Conclusion – Professor OY Elegba
Introduction
Professor OY Elegba
Department of Medical Microbiology
Introduction
• Ebola Virus Disease is a severe, highly infectious and often rapidly
fatal illness that first appeared in 1976 almost simultaneously in
Nzara, Sudan and Yambuku in the Democratic republic of Congo.
• They were of two different strains, the Sudan strain and the Zaire
strain.
• The natural reservoir was never identified.
• The third strain was discovered during necropsy in 1994 in Cote
D’Ivoire , a fourth, from Uganda called the Bundibugyo strain in
2008 and a fifth strain, the Reston strain was discovered accidentally
in a military laboratory, Virginia USA also in 2008 from samples
brought from the Phillipines.
Introduction
• EVD is caused by Ebola Virus belonging to a group of viruses
responsible for Viral hemorrhagic fevers like Lassa fever,
Yellow fever, Marburg and Dengue fever.
• They are called ‘hemorrhagic’ because of the distinct scary
bleeding that occur during the course of the illness.
• The word hemorrhagic is now left out in the case of Ebola
because the illness is not always accompanied by bleeding.
Introduction
• The virus is a complex level four pathogen.
• It is an enveloped RNA virus belonging to the family
Filoviridae,
genus
Ebolaviridae
and
order
Mononegavirales.
• Four of the five strains are known to have caused disease
in man.
• These are Zaire Ebola virus (EBOV previously ZEBOV),
Sudan Ebola virus (SUDV previously SEBOV), Tai forest
Ebola virus formerly known as Cote D’Ivoire Ebola virus
(TAFV previously CIEBOV), and Bundibugyo Ebola virus
(BDBV previously BEBOV.
Introduction
• The Reston strain has not been linked with any infections in
humans and is largely found in East Asia.
• The filoviridae has two other members which are Marburg
and Cuevavirus with Marburg said to be almost as vicious as
Ebola.
• The different strains of Ebola have different mortality rates
ranging between 50-90%.
• The deadliest of the strain is the Zaire strain which is
responsible for the present outbreak.
Introduction
• There have been several outbreaks in central and eastern
Africa but
• these outbreaks were all contained within few months.
• The total number of cases from all the previous outbreaks
were 2,387 and 1,590 deaths according to World Health
Organization in comparison with the the present outbreak
where over 4,000 cases and over 2,000 deaths have been
recorded.
• Presently, about six African countries have been affected
including Nigeria, Liberia, Senegal, Cote D’Ivoire, Guinea and
the Democratic Republic of Congo.
Introduction
The virus is transmitted from infected animals that live in the rain
forest through contact with blood and other body secretions.
It then spreads amongst humans in discriminatively.
Health workers and family members of the sick being most at risk.
It cannot be spread by airborne routes but can be spread by
droplets.
Current outbreak is characterized by eruption of symptoms 4-6 days
after exposure.
The outbreak has almost ‘crushed’ the countries affected both
economically and health wise especially in the way it decimates their
health workers.
It is also known that there is seropositivity in most regions of Africa
even in areas where no cases have been reported yet.
Introduction
• The origin of this virus is not known, but fruit bats
(Pteropodidae) are considered the most likely hosts
based on available evidence e.g the absence of clinical
signs in them is characteristic of a reservoir specie.
• High lethality in monkeys, chimpanzees, and gorillas
make them unlikely natural reservoirs
• Evidence has implicated that wild pigs and porcupine
may also be natural hosts to the virus
Introduction
• This virus cause havoc by first evading the dendritic cells and
macrophages thereby confusing the immune system of the
body.
• With it’s continued replication, the more powerful antibodies
and cytokines are produced massively resulting in what is
referred to as ‘cytokine storm’ characterized by the symptoms
and signs of the disease.
• This host response to the virus eventually affect all organs,
bursting blood vessels and causing bleeding both internally
and externally and also causing severe dehydration from the
vomiting and diarrhea resulting in low blood pressure and
death.
Introduction
• The current outbreak crossed porous borders and has been
going on for months.
• It has defied all predictions and it is impossible to predict how
it will end.
• Prof Langwick of Cornell University said, “Part of what we’re
seeing is our intense inter-connectedness in today’s world.
People travel. People need to travel to make their livelihoods,
to get food, to see relatives, to care for each other, for their
jobs and their profession. And I think we’re seeing a very
effective and devastating virus take advantage of the fact that
we are a very inter-connected world.”
Introduction
• There are no proven drugs or vaccines to treat or prevent
Ebola even though researches are going on along these lines.
• The rarity of the disease and it’s prevalence in largely poor
African nations has not provided enough incentive for big
pharmaceutical companies to tackle this virus.
• Only small biotechnological, pharmaceutical firms, and
Government funded laboratories have been attracted to this
forage and taken up the challenge. These companies and
groups are often poorly funded and do not have the where
with all to tackle such gigantic research programs and often
may not record huge successes.
Introduction
• The quick and horrible death of Ebola victims and the
potential threat of epidemics was captured in the 1994 best
selling non-fiction thriller “The Hot Zone” and “Outbreak”,
the epidemic is no longer just a threat, it is real. It is how we
will conquer it that is important, and conquer it we must.
• This virus has been considered a possible vehicle for
bioterrorism.
• The US CDC and Prevention lists the virus as a category A
Bioterrorism agent alongside Anthrax and Smallpox.
• All these must be addressed fully so that we will not be
caught “unprepared”.
Introduction
Epidemiology of EVD
Dr. MA Kana
Department of Community Medicine
Myths
• Bitter cola
• Salt wash and drink
• Kerosene bath
• Chlorine bath
• Research on going
Where is Ebola virus found in nature?
• Because the natural reservoir of ebola viruses
has not yet been proven
• The manner in which the virus first appears in
a human at the start of an outbreak is unknown
• However, researchers have hypothesized that
the first patient becomes infected through
contact with an infected animal
Ebola Landscape
Where do cases of Ebola virus disease occur?
• In the past Confirmed cases of Ebola HF have been
reported in the Democratic Republic of the Congo,
Gabon, Sudan, the Ivory Coast, Uganda, and the
Republic of the Congo
• Ebola HF typically appears in sporadic outbreaks,
usually spread within a health-care setting (a
situation known as amplification)
• It is likely that sporadic, isolated cases occur as well,
but go unrecognized
• When an infection does occur in humans, the virus can be
spread in several ways to others
• The virus is spread through direct contact (through broken
skin or mucous membranes) with
• a sick person's blood or body fluids (urine, saliva, feces,
vomit, breast milk and semen)
• objects (such as needles) that have been contaminated
with infected body fluids; home – cooking utensils,
towels, bed linen
• infected animals
• Handling of corpse and burial rites
• Other modes of transmission are being investigated
• Healthcare workers and the family and friends in
close contact with Ebola patients are at the highest
risk of getting sick because they may come in
contact with infected blood or body fluids
• During outbreaks of EVD, the disease can spread
quickly within healthcare settings (such as a clinic or
hospital)
• Exposure to ebola viruses can occur in healthcare
settings where hospital staff are not wearing
appropriate protective equipment, such as masks,
gowns, and gloves
Transmission and Infectivity
Distribution
Ebola outbreaks, 1976-2014
• The 2014 Ebola outbreak is the largest Ebola
outbreak in history and the first in West Africa
• The current outbreak is affecting multiple
countries in West Africa
• A number of cases in Lagos and Port Harcourt,
Nigeria, have been associated with a man from
Liberia who traveled to Lagos and died from
Ebola, but the virus does not appear to have
been widely spread in Nigeria
Burden
Case Counts
• Total Cases
• As of: August 31, 2014
• Suspected and Confirmed Case Count: 3707
• Suspected Case Deaths: 1848
• Laboratory Confirmed Cases: 2106
Nigeria
• Suspected and Confirmed Case Count: 21
• Suspected and Confirmed Case Deaths: 7
• Laboratory Confirmed Cases: 18
• Case fatality rate (CFR): 44%
Kaduna
• Suspected Case Count: 3 (Jaji, Zaria & Kagoro)
• Laboratory Confirmed Cases: 0
• Suspected and Confirmed Case Deaths: 0
• Case fatality rate (CFR): 0 %
• Risk for Kaduna State
• Air and road travel
• Hunters and bush meat consumption
• Porous border – illegal smuggling/aliens
Consequences of EVD
• Global pandemic - The combination of modern health systems
and the limited communicability of the virus make it unlikely to
spread in developed countries.
• Political right and freedom: On Aug. 6, Liberian President Ellen
Johnson Sirleaf declared a national emergency and suspended
constitutional rights for a 90-day period, citing “unrest” that
represents a “clear and present danger” to the country.
• Social - The virus has torn an already fragile society in affected
countries damaged from years of civil war
• Health system – overwhelmed resources and infrastructure,
loss of valuable human resource
• Economy – loss of revenue (tourism, trade, agriculture)
• Future of the impact: medical waste: scavenging and wildlife
migration, bioterrorism, national debt, political, economic and
social instability, threat to national security
Management of Ebola Virus
Disease(EVD)
Dr. Halima Bello-Manga
Department of Haematology
Management of EVD
The management of EVD is hinged on the following principles;
• Proper history and Physical Examination
• Lab investigation(diagnosis).
• Supportive therapy
Medical History
EVD in its initial phase mimicks many other febrile illnesses e.g.
malaria, common cold, typhoid fever, thus a high index of
suspicion has to be shown.
A history of exposure to the disease in the last 2-21 days prior to
the onset of symptoms should be established.
Exposure could be in the form of ;
• Contact with a person diagnosed with the disease e.g. caring
for, visiting or even a attending the burial of an infected
person. (Patients at risk include; health care workers, family
and friends, traditional healers, morticians, etc)
• Hx of contact with contaminated materials used by a patient
diagnosed with the disease, e.g. bed linen, eating utensils,
medical equipment, etc.
Medical History Cont’d
• Contact with infected animals e.g apes/chimpanzees, fruit
bats, pigs ( especially during processing) or eating.
• History of travel to endemic areas or contact with
someone with a hx of travel to such areas.
Diagnosis
Once a case of EVD is suspected, the person is isolated and
samples are sent for diagnosis. Samples are considered highly
infectious and should be treated as such.
Diagnostic investigations include;
• ELISA ( Ag capture, IgM Antibody)
• RT-PCR (confirmatory)
• IgM and IgG detection
• Virus isolation ( cell culture)
• Electron microscopy
• Immunohistochemistry( esp at post mortem).
Treatment
There is no specific treatment medicine/drug or vaccine for EVD.
(those available are in the trial phase) thus, the hallmark for the
Rx of the Dx remains SUPPORTIVE, which include;
• Provision of IV fluids and correcting electrolyte imbalances.
• Maintaining Oxygen saturation and blood pressure.
• Treating other secondary infections with antimicrobials.
• Good nutrition.
• Use of anticoagulants in cases of DIC.
Treatment Cont’d
• Blood transfusion ( blood from patients that have recovered
from EVD) seems to help and the WHO has approved its use
in the treatment of patients.
• In addition to the above, in actively bleeding patients with
DIC, blood transfusion is used in replacing clotting factors, red
cells and platelets( esp if component transfusion is done).
• Psychological support is a very important aspect in the mx of
ebola as the dx is associated with a lot of fear and anxiety
because of its high mortality rate.
Prognosis
EVD has a very high fatality rate of up to 90% ( when little or no
medical intervention is instituted), with supportive care, it
reduces to about 50% or lower with early appropriate
intervention.
Glimpses of Hope
• The current outbreak has caused a heightened international
response towards this emerging disease and the world
(mostly 1st world) has swung into action towards getting a
cure for the disease.
• The experimental drug ZMapp seems to be effective in the
treatment. ( not available for use now).
• At least 10 drugs and 2 vaccines against Ebola Virus dx are
currently under development (WHO).
Prevention and
Control
Dr. Faruk Adiri
Department of Community Medicine
Community Prevention and
Control
• Wash your hands regularly and properly – use soap, disinfectant
hand sanitizers
• Avoid physical contacts (hand shake, hugging, kissing)
• DO NOT touch, wash or kiss an infected person/ dead body
• Avoid their body fluids, including blood, vomit, faeces, urine
• DO NOT touch or eat “bush meat” and don’t eat bats
• Cook animal product thoroughly
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Community prevention and
Control
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Call your medical centre early and tell them about your illness
Listen to the advice/key massages.
You may be sent to a special hospital
Keep away from others so they don’t get sick
Be especially careful of your vomit and diarrhoea
Safe burial practices
Practice general sanitation/hygiene
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Prevention and Control-Animals
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During outbreaks quarantine premises/farms affected
PPE while handling animals
Cull infected animals
Incineration of carcasses
Supervise burials closely
Ban movements and sale of infected animals from affected areas
Active animal health surveillance
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Prevention and Control-Humans
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Raise awareness with key messages
Avoid close contact (within 1 meter)
Proper hand washing
PPE while handling patients
Standard precaution/procedure for infection control
Safe burial practice (incineration)
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Principles of Prevention
• Contact tracing
• Active case management
• Surveillance
• Kaduna State Ebola Response Committee
• Chaired by HE The Deputy Governor
• Technical committee
• Communications committee
Conclusion
• Ebola, supposedly does not travel through the air, making it
harder to transmit than other pathogens that cause epidemics
such as the Influenza virus.
• It has been established that with good health care practices,
the disease can be contained and may not be as vicious a killer
as other infections that have bedeviled us in the past.
• The Flu virus kills up to ½ a million every year and even as high
as 50 million during the great pandemic of 1917-1918, not to
mention emerging infectious diseases like resistant
tuberculosis, and even severe antibiotic resistance that has
now become a huge public health issue.
• So it is extremely important that we do not panic as fear can
drive sick people underground making contact tracing
impossible and aiding the spread to unaffected areas.
Conclusion
• The present outbreak started in Guinea and quickly spread to two
other West African countries which are about the poorest on earth.
• These countries are all inundated with poor health care, resulting in
challenges that are probably too heavy for them to bear.
• These, accompanied with the biases and prejudices of the local
populations, have made responses inadequate resulting into what
we have today.
• It may be necessary to involve All concerned, like, community
leaders, religious gurus and even traditional healers for effective
intervention as long as they are aware of the risks of Ebola as “good
healers are skillful in conceiving and promoting therapies that
intervene in the dynamics of biological diseases and human
relationships”
Conclusion
• Prof Langwick of Cornell University said that when people live
in an area with poor health facilities surrounded by death and
fear of death, it is an infuriating and terrifying situation which
can result in desperation.
• This desperation can result in distrust and violence as
happened recently in Liberia.
• How we care for our people especially in the face of danger is
very important and Prof Langwick described it very
appropriately as the ethics of living, the ethics of caring.
• This is the time to act and be prepared.
Conclusion
• As yet, we are lucky that Ebola is not in this part of the
country. So what is important now is for us to prevent it from
getting here and prepare for how we will control it if and
when it eventually gets here.
• We can play our parts by educating ALL around us, in our
homes, classes, religious settings etc etc.
• Correct politely, bad habits like spitting, sneezing without
covering the mouth and blowing of the nose publicly, and
teach people about basic infection control themes like
washing hands properly.
• Emphasis must be placed on how this disease is transmitted
especially amongst sick family members and about safe burial
practices.
Conclusion
• We must not let what happened in Liberia Guinea and Sierra
Leone be repeated here.
• Plan, Plan Plan. Identify health workers including
epidemiologists that will be capable of dealing with the
situation
• PPE and other essentials must be provided adequately. So also
we must have ambulances, and even train specially those who
will undertake burials.
• Link with local Government council chairmen so as to avoid
“shadow zones”
• Data collection is extremely important and epidemiological
surveillance must be instituted.
Conclusion
• Interestingly, caregivers at the front line bear the brunt of this
dreadful disease- a sobering fact being the demise of the five coauthors of an Ebola genome analysis study who died before even the
publication of their work.
• The research project published in the JOURNAL OF SCIENCE
sequenced the Ebola genome thus paving way for plotting mutation
and thereby finding the origin of the virus.
• The research has provided data about how the virus operates and
hopefully will help in the development of effective drugs and
vaccines.
• We must salute these fellows, MBALU FONNIE, ALEX MOGBOI, ALICE
KOROMA, MOHAMMED FULLAH AND SHEIK HUMARR KHAN who
died in the process of finding solution to the problem of Ebola.
• Coming nearer home, we must salute our health care workers like Dr
Stella Adadevoh and others who lost their lives in the process of
treating the Index case Patrick Sawyer..
Conclusion
• In a video which appeared in the White House website and
was aimed at West African countries struggling with the
outbreak, President Obama said “Stopping this disease won’t
be easy. But we know how to do it. You are not alone,
together we can treat those who are sick with respect and
dignity. We can save lives and our countries can work together
to improve Public Health so this kind of outbreak doesn’t
happen again”
• AND FINALLY
LET US ALL PREVENT EBOLA
THANK YOU FOR LISTENING
KADUNA STATE EBOLA HOTLINE
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