ศาสตราจารย์ ดรพิไลพนัธ์พธุวฒั...
TRANSCRIPT
Viral hemorrhagic fever and laboratory diagnosis
ศาสตราจารย ดรพไลพนธ พธวฒนะ
ศนยความรวมมอการวจยไขหวดใหญ ภาควชาจลชววทยา คณะแพทยศาสตรศรราชพยาบาล
มหาวทยาลยมหดล
การอบรมเชงปฏบตการ ldquoเครอขายหองปฏบตการโรคตดเชออบตใหม 2558rdquo โรงแรมลองบช ชะอ า 7 กรกฎาคม 2558
Viruses causing hemorrhagic fever (VHF)
At least 23 viruses from 4 families
bull Filoviridae
bull Arenaviridae
bull Bunyaviridae
bull Flaviviridae
Common characteristics of viruses causing HF
bull Enveloped virus with RNA genome
bull Wide range of natural hosts zoonotic
diseases and some are vector-borne viruses
bull Geographically restrict
Flaviviruses
bull Yellow fever virus- Yellow fever in tropical Africa and South America
bull Dengue viruses- DHF DSS
bull Omsk hemorrhagic fever virus- Omsk HF in Western Siberia
bull Kyasanur Forest disease virus - Kyasanur Forest disease in India
Bunyaviruses
bull Crimean-Congo hemorrhagic fever virus ndash Crimean-Congo HF in the Middle East Southern Europe and western China
bull Rift Valley fever virus- Rift Valley fever in Africa and Arabian Pennisula
bull Genus Hantavirus- hemorrhagic fever with renal syndrome in Eurasia
bull Severe fever with thrombocytopenia syndrome virus in China
Arenaviruses
bull Junin virus- Argentine HF
bull Machupo virus ndash Bolivian HF
bull Guanarito virus ndash Venezuelan HF
bull Sabia virus ndash Brazillian HF
bull Lassa virus ndashLassa HF in West Africa
bull Lujo virus- unnamed disease in Zambia
bull Chapare virus- unnamed disease in Bolivia
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Viruses causing hemorrhagic fever (VHF)
At least 23 viruses from 4 families
bull Filoviridae
bull Arenaviridae
bull Bunyaviridae
bull Flaviviridae
Common characteristics of viruses causing HF
bull Enveloped virus with RNA genome
bull Wide range of natural hosts zoonotic
diseases and some are vector-borne viruses
bull Geographically restrict
Flaviviruses
bull Yellow fever virus- Yellow fever in tropical Africa and South America
bull Dengue viruses- DHF DSS
bull Omsk hemorrhagic fever virus- Omsk HF in Western Siberia
bull Kyasanur Forest disease virus - Kyasanur Forest disease in India
Bunyaviruses
bull Crimean-Congo hemorrhagic fever virus ndash Crimean-Congo HF in the Middle East Southern Europe and western China
bull Rift Valley fever virus- Rift Valley fever in Africa and Arabian Pennisula
bull Genus Hantavirus- hemorrhagic fever with renal syndrome in Eurasia
bull Severe fever with thrombocytopenia syndrome virus in China
Arenaviruses
bull Junin virus- Argentine HF
bull Machupo virus ndash Bolivian HF
bull Guanarito virus ndash Venezuelan HF
bull Sabia virus ndash Brazillian HF
bull Lassa virus ndashLassa HF in West Africa
bull Lujo virus- unnamed disease in Zambia
bull Chapare virus- unnamed disease in Bolivia
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Common characteristics of viruses causing HF
bull Enveloped virus with RNA genome
bull Wide range of natural hosts zoonotic
diseases and some are vector-borne viruses
bull Geographically restrict
Flaviviruses
bull Yellow fever virus- Yellow fever in tropical Africa and South America
bull Dengue viruses- DHF DSS
bull Omsk hemorrhagic fever virus- Omsk HF in Western Siberia
bull Kyasanur Forest disease virus - Kyasanur Forest disease in India
Bunyaviruses
bull Crimean-Congo hemorrhagic fever virus ndash Crimean-Congo HF in the Middle East Southern Europe and western China
bull Rift Valley fever virus- Rift Valley fever in Africa and Arabian Pennisula
bull Genus Hantavirus- hemorrhagic fever with renal syndrome in Eurasia
bull Severe fever with thrombocytopenia syndrome virus in China
Arenaviruses
bull Junin virus- Argentine HF
bull Machupo virus ndash Bolivian HF
bull Guanarito virus ndash Venezuelan HF
bull Sabia virus ndash Brazillian HF
bull Lassa virus ndashLassa HF in West Africa
bull Lujo virus- unnamed disease in Zambia
bull Chapare virus- unnamed disease in Bolivia
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Flaviviruses
bull Yellow fever virus- Yellow fever in tropical Africa and South America
bull Dengue viruses- DHF DSS
bull Omsk hemorrhagic fever virus- Omsk HF in Western Siberia
bull Kyasanur Forest disease virus - Kyasanur Forest disease in India
Bunyaviruses
bull Crimean-Congo hemorrhagic fever virus ndash Crimean-Congo HF in the Middle East Southern Europe and western China
bull Rift Valley fever virus- Rift Valley fever in Africa and Arabian Pennisula
bull Genus Hantavirus- hemorrhagic fever with renal syndrome in Eurasia
bull Severe fever with thrombocytopenia syndrome virus in China
Arenaviruses
bull Junin virus- Argentine HF
bull Machupo virus ndash Bolivian HF
bull Guanarito virus ndash Venezuelan HF
bull Sabia virus ndash Brazillian HF
bull Lassa virus ndashLassa HF in West Africa
bull Lujo virus- unnamed disease in Zambia
bull Chapare virus- unnamed disease in Bolivia
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Bunyaviruses
bull Crimean-Congo hemorrhagic fever virus ndash Crimean-Congo HF in the Middle East Southern Europe and western China
bull Rift Valley fever virus- Rift Valley fever in Africa and Arabian Pennisula
bull Genus Hantavirus- hemorrhagic fever with renal syndrome in Eurasia
bull Severe fever with thrombocytopenia syndrome virus in China
Arenaviruses
bull Junin virus- Argentine HF
bull Machupo virus ndash Bolivian HF
bull Guanarito virus ndash Venezuelan HF
bull Sabia virus ndash Brazillian HF
bull Lassa virus ndashLassa HF in West Africa
bull Lujo virus- unnamed disease in Zambia
bull Chapare virus- unnamed disease in Bolivia
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Arenaviruses
bull Junin virus- Argentine HF
bull Machupo virus ndash Bolivian HF
bull Guanarito virus ndash Venezuelan HF
bull Sabia virus ndash Brazillian HF
bull Lassa virus ndashLassa HF in West Africa
bull Lujo virus- unnamed disease in Zambia
bull Chapare virus- unnamed disease in Bolivia
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Filoviruses
bull Marburg virus ndash emerged in 1967 in Marburg Germany and Yugoslavia
bull Ebolavirus- emerged in 1976 in Zaire (DR Congo) and Sudan
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
VHF in Africa
bull Flaviviridae Yellow fever virus
bull Arenaviridae Lassa fever virus
bull Filoviridae Marburg virus
Ebola virus
bull Bunyaviridae
Crimean-Congo hemorrhagic fever virus
Rift Valley fever virus
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
VHF in Thailand
bull Dengue virus types 1-4
bull Hantaan virus
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Pathogenic mechnisms of VHF
bull Vascular damage increased vascular permeability and plasma leakage
bull Hemorrhage
bull Hepatocellular necrosis leads to deficiency of coagulation factors
bull Complement activation
bull Disseminated intravascular coagulation
bull Cytokine storm
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Re-emergence of Ebola virus disease
bull The EVD outbreak began in December 2013 and reported to WHO on 21 March 2014
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
13
Ebola signs and symptoms
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Classification of Ebola virus
Order Mononegavirales
Family Filoviridae
Genus Marburgvirus
Genus Ebolavirus
Zaire ebolavirus (EBOV) Fatality rate 70-90
Sudan ebolavirus (SUDV) 40-60
Bundibugyo ebolavirus (BDBV) 32
Taiuml Forest ebolavirus (TAFV)
Reston ebolavirus (RESTV)
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Phylogenetic Analysis of the Ebolavirus Genus Including the EBOV Strains from Guinea
Emergence of Zaire Ebola Virus Disease in Guinea - Preliminary Report N Engl J Med 2014 Apr 16
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Confirmed probable and suspected EVD cases worldwide (data up to 31 May 2015)
Source WHO EBOLA SITUATION REPORT
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Figure 3 Distribution of EVD cases in Guinea and Sierra Leone by week of reporting as of week 262015
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Current situation
bull As of 27 June 2015 WHO has reported 27 541 cases with 11 235 deaths
bull Guinea
bull Sierra Leone
bull According to the last confirmed case on 27 March 2015 Liberia declared EVD free on 9 May 2015 New case was found on 29 June 2015 and number of cases is rising
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Overview of EVD outbreaks 1976ndash2014
European CDC as of 27 July 2014
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Why the 2014-2015 outbreak is more serious than previous ones
bull From 1976 to 2014 Ebolavirus is evolving but no change which leads to functional change
bull Wide spread of 2014 outbreak was due to epidemiological factors
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Organisation drsquoune ldquoClinique Ebola
Conakry Guinea
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
22
Mesures preacuteventives Prise encharge
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Sources of infection
bull Animals
bull Human body fluids
Blood urine feces sweat
nasal secretion sputum breast milk
genital secretion semen
aqueous humor of a uveitis case
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Hypsignathus monstrosus Hammer-headed fruit bat Big-lipped bat
Myonycteris torquata Epomops franqueti
Ebola outbreaks in DRC in 2007-2008 was associated with massive migration of fruit bats
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Routes of infection
bull Mucous membrane skin abrasion
bull Ingestion of contaminated food
bull Airborne transmission is unlikely Aerosols
bull Human to human transmission
Close contact
Sexual transmission possible ndash recommended 3 mo after onset
Dead ceremony
Incubation period 2-21 days
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
General properties of Ebola virus
bull RNA genome of negative polarity linear about 18 959 nucleotides long 80 nm wide
bull Envelope
bull Filamentous shape
bull Carry enzyme RNA dependent
RNA polymerase (replicase)
in virion
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Ebola virus virion
httpviralzoneexpasyorgall_by_species207html
970 nm long 80 nm diameter
IFN antagonist Interfere IFN signalling
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Target cellsorgans for virus replication
bull Monocytesmacrophages
bull Dendritic cells
bull Endothelial cells
bull Hepatocytes
bull Adrenal cortical cells
bull Parenchymal cells of various organs
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Ebola virus pathogenesis
Feldmann Lancet 2011 377(9768)849-62
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Ebolavirus stability
bull Virus inactivation- gamma irradiation
- heating at 60 C for 60 min
- boiling for 5 min
bull Sensitive to sodium hypochlorite (bleach)
bull Survive in liquid or dried materials for many days
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Ebola virus genome
bull GP- glycoprotein sGP ndash secreted glycoprotein
bull N ndash nucleoprotein VP30 ndash component of nucleocapsid
bull L ndash polymerase enzyme VP35 ndashpolymerase complex protein
bull VP40- major matrix protein VP24- minor matrix protein
bull Nucleocapsid is a complex of NP VP35 VP30 and L
httpviralzoneexpasyorgall_by_species207html httpgooglegooglecomari_fundamentalsofmicrobiology_7_microbialgeneticshtm
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Laboratory diagnosis of Ebola virus
bull Specimens blood samples tissues specimen handling
bull Genome detection by RT-PCR
bull Antigenantibody detection in sera by ELISA
bull Virus isolation in Vero E6 required BSL 4 facilities
bull Electron microscopy
Low viral load is correlated with survival
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Differential diagnosis of EVD
bull Malaria
bull Lassa fever
bull Yellow fever
bull Leptospirosis
bull Typhoid
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Marburg virus
bull First discover in 1967 in Marburg and Frankfurt Germany and in Belgrade Serbia (Yugoslavia)
bull Source of infection African Green monkeys from Uganda
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Marburg hemorrhagic fever outbreak
bull Germany and Yugoslavia 1967
bull South Africa (origin from Zimbubwe ) 1975
bull Kenya 1980 1987
bull DR Congo 1998-2000
bull Angola 2004-2005
bull Uganda 2007 2012
bull 1990 Lab contamination in Russia
bull 2008 USA and Netherlands ex Uganda
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Marburg hemorrhagic fever
bull Incubation period 5-10 days
bull High fever severe headache severe malaise severe watery diarrhea abdominal pain and cramping CNS involvement
bull Bleeding- fresh blood in vomitus and feces nose gum and vagina venepuncture site
bull Death between day 8 and 9 and usually precedes by severe blood loss and shock
bull Case fatality rate 23-90
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Transmission
bull Fruit bats Rousettus aegypti of the family Pteropidae are reservoir hosts
bull Transmission from bats to human may occur through contact with bat feces or aerosols
bull Transmission from primates
bull Human to human transmission contact to blood secretions body fluidstissues semen or contaminated equipment (household contact nosocomial infection burial ceremony)
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Pteropid bats
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Lassa fever virus
bull First report in the town named Lassa in Nigeria in 1969 in 2 American missionaries who died from the disease
bull It is endemic in West Africa in Sierra Leone Liberia Guinea and Nigeria
bull Cases reported from Ivory coast Mali Ghanahellip
bull Estimated number 100000 to 300000 cases with approximately 5000 deaths per year
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Signs and symptoms
bull 80 of Lassa fever virus infection are mild and undiagnosed
bull 20 of the cases progress to severe disease and hemorrhage repeated vomiting facial swelling pain in chest back and abdomen and shock Deafness is the most common complication
bull Death occurs from multi-organ failure
bull Fatality rate 1 or 15-20 of hospitalized cases
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Transmission of Lassa virus
bull Mastomys rodents live in savannas and forest and around home Rodents shed the virus in urine and droppings
bull Man gets infection through ingestion and inhalation
bull Human to human transmission through contact with blood secretions excretion and tissues and also nosocomial infection
bull Incubation period 1-3 weeks
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Reservoir host of Lassa virus is a rodent known as the multimammate rat (Mastomys natalensis)
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Yellow fever virus
bull The first virus known to cause human infection
bull The first virus known to be transmitted by insect vector
bull The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Panama canal locks
The French officially abandoned efforts to build the Panama Canal and transferred the rights to the project to the United States in part because of the yellow fever and malaria deaths among the projectrsquos workers
The French Panama Canal Effort 1882ndash1889
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Areas with risk of yellow fever virus transmission
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Aedes aegypti
Vector for Dengue virus Chikungunya virus Yellow fever virus
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Yellow fever vaccine
Live attenuate vaccine strain 17D was developed by Max Theiler in 1937
Protection begins by the 10th day after vaccination in 95 of people and last for at least 10 yrs
Nobel Prize laureate 1950
Max Theiler
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Lab diagnosis of dengue virus infection
bull Genome detection by RT-PCR
bull Paired blood
- Hemagglutination-inhibition (HI) test
lt 1280 primary infection
gt 2560 secondary infection
- Plaque reduction neutralization test
bull ELISA IgGIgM
bull NS1 AgAb
bull Cross reaction with other flaviviruses
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Mahanty S Bray M Lancet Infect Dis 20044(8)487-98
Vascular leakage Coagulopathy Apoptosis
Inhibition of adaptive responses
Inhibition of innate immune responses
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Chronology of previous Ebola virus disease outbreaks
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
bull Crisis of climate and environmental changes do not affect only man but also animals
Global warming flood and smoke from fire destroys animalrsquos habitats
bull Animal migration and movement
Bats will be an important source of novel agents
One world one health
Our future
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Family Filoviridae is classified into 2 genera Genus Marburgvirus Genus Ebolavirus
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Symptoms of VHF
bull Specific signs and symptoms vary by type of VHF but the initial signs and symptoms is nonspecific and difficult to provide differential diagnosis
bull Initial symptoms high fever fatigue loss of strength muscle aches
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
West Africa Ebola virus disease epidemic curve
Source httpvirologydownunderblogspotcomau201407ebola-virus-disease-evd-2014-westhtml
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Figure 2 Distribution of confirmed cases of EVD by week of reporting Guinea and Sierra Leone weeks 462014 to 262015
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557
Zaire ebolavirus ซงมอตราตายสงถงรอยละ 70-90 รองลงมาคอ Sudan ebolavirus มอตราตายรอยละ 40-60 และ Bundibugyo ebolavirus มอตราตายประมาณรอยละ 32 ส าหรบเชอตนเหตของการระบาดทเกดขนในปจจบนคอ Zaire ebolavirus การระบาดเรมขนในประเทศกน ตงแตเดอนมกราคม และไดรายงานตอองคการอนามยโลกในวนท 21 มนาคม พศ
2557