EBOLA VIRUS DISEASE

INTRODUCTION

 Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe,
often fatal illness affecting humans and other primates.

 It was named after the name of a river in Congo where it was first found.

 Ebola virus disease (EVD) is a severe disease caused by Ebola virus, a member of the
filovirus family, which occurs in humans and other primates.

EPIDEMIOLOGY

 The disease emerged in 1976 in almost simultaneous outbreaks in the Democratic

Republic of the Congo (DRC) and Sudan (now South Sudan). In these two instances the
mortality rate was between 50-90%

 The largest outbreak to date took place in West Africa between March 2014 and June
2016, affecting primarily Guinea, Liberia and Sierra Leone. Over 28,000 cases were
recorded.

 There are 6 species of Ebola virus, 4 of which have caused disease in humans:

 Zaïre ebolavirus (EBOV)

 Sudan ebolavirus (SUDV)

 Tai Forest (TAFV) (formerly known as Ebola Ivory Coast)

 Bundibugyo ebolavirus (BDBV)

RESERVOIR

 Ebola is believed to be zoonotic, however, the natural reservoir is unknown, despite

extensive investigations. Non-human primates have been a source of human infection,
however, they are not thought to be the reservoir as they develop severe, fatal illness
when infected.

 Harvesting of migrating fruit bats was thought to be the source of a large outbreak in the
DRC in 2007.

TRANSMISSION

 The virus is transmitted to people from wild animals (such as fruit bats, porcupines and
non-human primates such as apes and monkeys), and then spreads in the human
population through direct contact with the blood, secretions, organs or other bodily
fluids of infected people,

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 The virus is then transmitted from person to person through direct contact with the
blood, secretions, organs or other bodily fluids of infected persons.

 People can also become infected through contact with objects, such as unsterilized
needles, and with surfaces and materials (e.g. bedding, clothing) contaminated with these
fluids. etc.

 Outbreaks have been fueled by traditional burial practices, in which mourners have direct
contact with the bodies of the deceased. Acquisition via sexual contact with a
convalescent case or survivor has been documented. the virus can be present in semen for
many months after recovery.

 Hospital workers have frequently been infected during Ebola outbreaks through close
contact with infected patients, and insufficient use of correct infection control precautions
and barrier nursing procedures.

 Ebola is not spread through routine, social contact (such as shaking hands or sitting next
to someone) with asymptomatic individuals. There is no evidence of transmission of
Ebola virus through intact skin or through small droplet spread, such as coughing or
sneezing.

 A person can only spread Ebola to other people after they develop signs and symptoms of
Ebola.

 Additionally, Ebola virus is not known to be transmitted through food. However, in

certain parts of the world, Ebola virus may spread through the handling and consumption
of wild animal meat or hunted wild animals infected with Ebola. There is no evidence that
mosquitoes or other insects can transmit Ebola virus.

INCUBATION PERIOD

 The incubation period of Ebola virus disease ranges from 2 to 21 days.

PATHOPHYSIOLOGY

 Ebola virus get in to the body via mucus membrane of nose, Eyes, or broken skin.

 Immune system gets attacked by the virus, by attacking monocytes, macrophages and
dendritic cells (which are responsible for alerting the rest of body immune cells to finish
Ebola virus).

 Immune cells will return to Ebola virus producing machine instead of getting rid of the
virus.

 As soon as the dendritic cells become infected T-Cells and natural killer cells also die off,
further crippling the immune system.

 While this is happening infected macrophages will start to release large amount of protein
called cytokines.

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 Normally immune system use cytokines to talk to one another, these cytokines can cause
inflammation allowing the body cells to kill foreign invaders.

 Normally immune cells release enough cytokines to get the job done without harming the
body, but when Ebola virus infect macrophages they produce cytokines and other
molecules uncontrollably.

 The excessive release of cytokines and other molecules sets off a series of damaging
events throughout the body.

 Molecules release by macrophages form clots in the small blood vessels, this condition is
called disseminated intravascular coagulation. Other molecules weaken blood vessels
making blood and plasma leak out.

 Both of these limit blood flow to many organs depriving them of oxygen.

 As the disease progresses virus spread to body organs such as the liver, kidney, spleen
and lymph node. Dying macrophages in these organs release their own cytokines and
thus, telling the living cells to send out more of these molecules until the body is
overwhelmed and the organs suffer a lot of damage which might eventually lead to the
death of an individual.

SIGN AND SYMPTOMS

 Symptoms may appear anywhere from 2 to 21 days after contact with the virus, with an
average of 8 to 10 days. The course of the illness typically progresses from “dry”
symptoms initially (such as fever, aches and pains, and fatigue), and then progresses to
“wet” symptoms (such as diarrhea and vomiting) as the person becomes sicker.

 Primary signs and symptoms of Ebola often include some or several of the following:

 Fever (38.8oc)

 Aches or pains, such as severe headache, muscle and joint pain

 Weakness and fatigue

 Sore throat

 Loss of appetite

 Coughing

 Gastrointestinal symptoms including abdominal pain, diarrhea, and vomiting(blood).

 Unexplained hemorrhaging both internal and external bleeding from the orifices (nose,
mouth, skin and eyes).

 Other symptoms may include red eyes, skin rash, impaired kidney and liver function and
hiccups (late-stage).

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 Ebola virus disease is fatal in between 40 to 90% of all clinically ill cases, depending on
the virus species, patients’ age and many other factors.

DIAGNOSTIC PROCEDURES

 Polymerase chain reaction (PCR) is one of the most commonly used diagnostic methods
because of its ability to detect low levels of Ebola virus. PCR methods can detect the
presence of a few virus particles in small amounts of blood, but the ability to detect the
virus increases as the amount of virus increases during an active infection. When the virus
is no longer present in great enough numbers in a patient’s blood, PCR methods will no
longer be effective.

 Antibody-capture enzyme-linked immunosorbent assay (ELISA)

 Antigen-capture detection tests

 Serum neutralization test

 Reverse transcriptase polymerase chain reaction (RT-PCR) assay

 Electron microscopy

 Virus isolation by cell culture.

AT RISK GROUP

 Health workers who do not use proper infection control while caring for Ebola patients,
and family and friends in close contact with Ebola patients, are at the highest risk of
getting sick. Ebola can spread when people come into contact with infected blood or body
fluids.

 Ebola poses little risk to travelers or the general public who have not cared for or been in
close contact (within 3 feet or 1 meter) with someone sick with Ebola.

NURSING MANAGEMENT

 Maintenance of oxygenation

 Maintenance of blood pressure

 Pain management/control

 Nutritional support

 Balancing of fluid and electrolytes to counter dehydration.

 Administration of prescribed anti coagulants early in infection to prevent or control

disseminated intravascular coagulation.

 Administration of prescribed procoagulants late in infection to control bleeding.

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MEDICAL MANAGEMENT

Supportive Care

 Whether or not other treatments are available, basic interventions can significantly
improve chances of survival when provided early. These are referred to as supportive
care, and include:

 Providing fluids and electrolytes (body salts) orally or through infusion into the vein
(intravenously).

 Using medication to support blood pressure, reduce vomiting and diarrhea, and to
manage fever and pain.

 Treating other infections, if they occur.

 There are currently two treatments approved by the U.S. Food and Drug Administration
(FDA) to treat EVD caused by the Ebola virus, species Zaire ebolavirus, in adults and
children. The first drug approved in October 2020, Inmazeb is a combination of three
monoclonal antibodies. The second drug, Ebanga, is a single monoclonal antibody and
was approved in December 2020. Monoclonal antibodies (often abbreviated as mAbs) are
proteins produced in a lab or other manufacturing facility that act like natural antibodies
to stop a germ such as a virus from replicating after it has infected a person. These
particular mAbs bind to a portion of the Ebola virus’s surface called the glycoprotein,
which prevents the virus from entering a person’s cells.

 Neither Inmazeb nor Ebanga have been evaluated for efficacy against species other than
Zaire ebolavirus.

PREVENTION

The U.S. Food and Drug Administration (FDA) has approved the Ebola vaccine rVSV-
ZEBOV (tradename “Ervebo”) for the prevention of EVD. The rVSV-ZEBOV vaccine has
been found to be safe and protective against only the Zaire ebolavirus species of ebolavirus.

Prevention focuses on avoiding contact with the viruses. The following precautions can help
prevent infection and spread of Ebola virus;

 Avoid areas of known outbreaks. Before traveling to Africa, find out about current
epidemics by checking the Centers for Disease Control and Prevention website.

 Wash your hands frequently. As with other infectious diseases, one of the most
important preventive measures is frequent hand-washing. Use soap and water, or use
alcohol-based hand rubs containing at least 60% alcohol when soap and water aren't
available.

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 Avoid bush meat. In developing countries, avoid buying or eating the wild animals,
including nonhuman primates, sold in local markets.

 Avoid contact with infected people. In particular, caregivers should avoid contact with
an infected person's body fluids and tissues, including blood, semen, vaginal secretions
and saliva. Also avoid the person's clothing, bedding or other items that may have
touched him or her. People with Ebola virus are most contagious in the later stages of the
disease.

 Follow infection-control procedures. If you're a health care worker, wear specialized

personal protective equipment that covers you from head to toe. Keep people who have
the viruses isolated from others. Safely throw away needles and sterilize other
instruments.

 Don't handle remains. The bodies of people who have died of Ebola virus are still
contagious. Specially organized and trained teams should bury the remains, using
appropriate safety equipment.

 When living in or traveling to a region where Ebola virus is potentially present, there are
a number of ways to protect yourself and prevent the spread of EVD.

 Avoid contact with blood and body fluids (such as urine, feces, saliva, sweat, vomit,
breast milk, amniotic fluid, semen, and vaginal fluids) of people who are sick.

 Avoid contact with semen from a man who has recovered from EVD, until testing shows
that the virus is gone from his semen.

 Avoid contact with items that may have come in contact with an infected person’s blood
or body fluids (such as clothes, bedding, needles, and medical equipment).

 Avoid funeral or burial practices that involve touching the body of someone who died
from EVD or suspect EVD.

 Avoid contact with bats, forest antelopes, and nonhuman primates (such as monkeys and
chimpanzees) blood, fluids, or raw meat prepared from these or unknown animals
(bushmeat).

On February 26, 2020, the Advisory Committee on Immunization Practices

(ACIP) recommended pre-exposure prophylaxis vaccination with rVSV-ZEBOV for adults ≥
18 years of age in the U.S. population who are at potential occupational risk of exposure to
Zaire ebolavirus. This recommendation includes adults who are

 Responding or planning to respond to an outbreak of EVD;

 Laboratorians or other staff working at biosafety-level 4 facilities that work with live
Ebola virus

COMPLICATIONS

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Ebola virus lead to death for a high number of people who are affected. As the illnesses
progress, the viruses can cause:

 Multiple organ failure

 Severe bleeding

 Jaundice

 Delirium

 Seizures

 Coma

 Shock

One reason the viruses are so deadly is that they interfere with the immune system's ability to
mount a defense. But scientists don't understand why some people recover from Ebola virus
and others don't.

For people who survive, recovery is slow. It may take months to regain weight and strength,
and the viruses remain in the body for weeks. People may experience:

 Hair loss

 Sensory changes

 Liver inflammation (hepatitis)

 Weakness

 Fatigue

 Headaches

 Eye inflammation

 Testicular inflammation