DR. FRANCES R.

WURIE-
SESAY
EBOLA HAEMORRHAGIC
FEVER
PRESENTATION: EHF
INTRODUCTION
BRIEF HISTORY
NATURAL HISTORY
MODE OF TRANSMISSION
SIGNS AND SYMPTOMS
DIAGNOSIS
TREATMENT
PROGNOSIS
PREVENTION
RECOMMENDATIONS
INTRODUCTION
ONE of the many viral haemorrhagic fevers.
Caused by the Ebola Virus: Named after the Ebola
River




BRIEF HISTORY

EBOV: 26 August 1976 in Yambuku
.
The first recorded case was
Mabalo Lokela, a 44-year-old schoolteacher.
SEBOV: cotton factory workers in Nzara, Sudan, with the first
case reported as a worker exposed to a potential natural reservoir
REBOV: Reston ebolavirus . Discovered during an outbreak of
simian hemorrhagic fever virus (SHFV) in 1989.
TAFV: Also referred to as Ta Forest ebolavirus , it was first
discovered among chimpanzees from the Ta Forest in 1994. One
of the scientists contracted Ebola.
BEDOV: Bundibugyo ebolavirus. November 2007--Uganda
DRC 1976
Cases:
318
Deaths:
280
NATURAL HISTORY
Bats drop partially eaten fruits and pulp, then
terrestrial mammals such as gorillas and monkeys
feed on these fallen fruits.
Dead animal(bush) hunter family(village)
community
city
Outbreaks are usually traceable to a single index
case where an individual has handled the carcass of
gorilla, chimpanzee, or an infected human corpse.
Fruit bats are also reported to be a treat eaten by
people in parts of West Africa.
NATURAL HOST
FRUIT EATING
BAT
Cultural Delicacies
Ghanaian Savory
Dried Bats
MODE OF TRANSMISSION

Through close contact with the blood, secretions,
organs or other bodily fluids of infected animals.
Through human-to-human transmission, resulting from
close contact with the blood, secretions, organs or other
bodily fluids of infected people, thru broken skin or
mucous membranes.
Direct contact with the body of the deceased infected
person.
Transmission via infected semen can occur up to eight
weeks after clinical recovery.
MODE OF TRANSMISSION
CONTD

Health-care workers have frequently been infected
while treating Ebola patients. (infected sharp objects)

At Risk?????-------health workers and family members
SIGNS AND SYMPTOMS (S/S)

The incubation period (interval from infection to onset of
symptoms) varies between 2 to 21 daysAVG13
Sudden onset of fever, intense weakness, muscle pain,
headache and sore throat.
This is followed by vomiting, diarrhoea (w or w/o blood),
rash, impaired kidney and liver function, and in some
cases, both internal and external
bleedingINDICATIVE OF NEG PROGNOSIS.

SIGNS AND SYMPTOMS (S/S)
CONTD
SEIZURES
AGITATION
SKIN
MANIFESTATIO
N


SIGNS AND SYMPTOMS (S/S)
EPISTAXIS
SUBCONJUCTIVAL

HAEMORRHAGE








EVD's most important clinical indicator is the
persons medical history, especially travel and
occupational history and the patient's
exposure to wildlife.

SUSPECTED CASE :s/s plus history of travel
or contact
PROBABLE CASE: s/s plus history of contact
with death without lab inv/
CONFIRMED CASE: after lab diagnosis

DIAGNOSIS
DIAGNOSTIC METHODS

Laboratory findings show low counts of white blood cells
and platelets as well as elevated liver enzymes.
Ebola virus infections can only be diagnosed definitively in
the laboratory by a number of different tests:
Enzyme-linked immunosorbent assay (ELISA)
Antigen detection tests
Serum neutralization test
Reverse transcriptase polymerase chain reaction (RT-
PCR) assay
Virus isolation by cell culture.



TREATMENT
NO CURE
NO VACCINE

TREATMENT IS MAINLY SUPPORTIVE
ISOLATION
1. FLUIDS
2. OXYGEN
3. ANALGESICS
4. ANTIPYRETICS
5. BLOOD TRANSFUSION
DIFFERENTIAL DIAGNOSIS

Malaria
Typhoid fever
Shigellosis
Cholera
Meningitis
Hepatitis
Other VHFs LASSA FEVER, MARBURG, CONGO-
CRIMEAN

PROGNOSIS
In general, outcomes are poor with 68% of all cases
resulting in death; 90% with EBOV
If an infected person survives, recovery may be quick
and complete, or prolonged with long term problems,
such as inflammation of the testicles, joint pains, skin
peeling, or alopecia.
Eye symptoms, such as light sensitivity, excess tearing,
and blindness have also been described.
EBOV and SUDV may be able to persist in the sperm
of some survivors, which could give rise to secondary
infections and disease.
PROBABILITY OF EPIDEMIC
The potential for widespread Ebola Viral Diease (EVD)
epidemics could be considered low due to the high
case-fatality rate, the rapidity of demise of patients, and
the often remote areas where infections occur(poor
road network)
The need to seek medical assistance may predispose
individuals to migrate, thereby spreading the infection.


THE SIERRA LEONE
CONNECTION
FIRST CASE LOCATION CONFIRMED DEATH
S
CASE
FATALITY
RATE
FEB 2014 GUINEA 328 208 63%
MAR 2014 LIBERIA 13 10 77%
MAY 25,
2014
SIERRA LEONE 42 12 28.6%
1
7
14
15
18
24
SIERRA LEONE CASE TREND
SIERRA LEONE SUSPECTED
CASES= 123

PREVENTION
Educational public health messages for risk
reduction should focus on several factors.
Reducing the risk of wildlife-to-human transmission
from contact with infected fruit bats or monkeys/apes
and the consumption of their raw meat.
AVOID direct or close contact with infected people,
particularly with their bodily fluids.
Regular hand washing is required.


PUBLIC AWARENESS
CAMPAIGNS

PREVENTION
Barrier nursing techniques include:
wearing of protective clothing (such as masks, gloves,
gowns, and goggles)
the use of infection-control measures (such as
complete equipment sterilization and routine use of
disinfectant)
isolation of Ebola HF patients from contact with
unprotected persons.

PERSONAL PROTECTIVE
EQUIPMENT
Gown or suit (WATERPROOF)
Apron
Boots
Gloves
Mask
Headcover
Googles

HANDWASHING VS. HAND
SANITIZER
1g of faeces contains 3 trillion germsE. Coli, Salmonella etc

The virus has a lipid covering. So simple soap and water
will kill it.
Hand washing should last 15-30sec
Sanitizer effective with at least 60% alcohol---right amount/air
dry/clean hands
Triclosan -- bacterial resistance

less handwashing/sanitizing = more chance to spread
disease
DISINFECTION/INFECTION
CONTROL
Sensitive to alcohol, heat, bleach (concentration)----
1:10 and 1:100
UNIVERSAL NURSING BARRIERS
Safe sharps disposal
Incineration
ABERDEEN WOMENS CTR (AWC)
ISOLATION UNIT
AWC ISOLATION UNIT

BEING CAUTIOUS
If someone vomits in the office
Use gloves to clean and dispose of clean up in toilet and
flush
DO NOT DISPOSE OF IN GUTTER OR PUBLIC AREA
If someone is bleeding from nose/ears/mouth
DO NOT ASSIST WITHOUT THE USE OF GLOVES
REFER TO NEAREST HOSPITAL
Drivers
Have gloves in your cars if you need to assist anyone with
the symptoms
Feet-on-the-street
Always have sanitizer and use before entering
households/businesses
Be aware of the sign and symptoms and look for them in
your surroundings
Wear long sleeves when in taxis or public transport
RECOMMENDATIONS
STAFF: NORMAL PERONAL HYGIENE---BATHROOM
USE
STAFF: FREQUENT AND PROPER HANDWASHING ---
AIR DRY OR DISPOSABLE PAPER TOWELS
WHERE APPLICABLE PLEASE USE GLOVES
FREQUENTLY WIPE DOWN WITH BLEACH DOOR
HANDLES, CASHIER/CSO COUNTERS, AND ANY AREA
WHERE THERE IS HIGH TRAFFIC. USE GLOVES.
SANITIZER USE BEFORE ENTRY FOR CUSTOMERS
SANITIZER USE THROUGHOUT THE DAY
RECOMMENDATIONS
LIMIT HANDSHAKING, HUGGING
EMPLOYEES SHOULD BE EXTRA CAUTIOUS
MONITOR VISITORS FROM AREAS WITH
REPORTED CASES
AVOID CONTACT WITH SICK PEOPLE


THANK
YOU!

QUESTIONS & COMMENTS