Ebola Hemorragic Fever EVD

Ebola Viral Disease(EVD)What you need to know about Ebolavirus and the 2014 West Africa outbreakWhy is Ebola capitalized while other infectious agents such as malaria, rabies or influenza are not?1

Ebola Viral Disease(EVD)DiscoveryVirology 101Hemorrhagic VirusesMode of TransmissionSigns and SymptomsPathologyEcology of EbolaPast OutbreaksGlobal ResponseDiagnosisTreatmentTherapies & VaccinesControl of SpreadMisinformationMoving AheadBe a Superhero Q&AWhy is Ebola capitalized while other infectious agents such as malaria, rabies or influenza are not?2

Ebola Viral Disease(EVD)Why is Ebola capitalized, while other viruses measles, polio, influenza are not?Why is Ebola capitalized while other infectious agents such as malaria, rabies or influenza are not?5

The Ebolavirus is named after the Ebola river where it was first isolated and identified in 1976. 6

Zaire species of Ebola

First identified: 1976

Common pathology:Purpura

Nikondi art:Kingdom of KongoCirca 1500

Representation:Disease protectionCysts & purpura

Virology 101Genes- A unit of genetic material containing the information needed to produce and regulate a single protein.

Capsid- The protein coat that surround the genetic material of a virus.

Envelope- A membranous covering found on some virus capsids that allows the virus to enter a host cell by fusing with the host's cell membrane.

Enzymes- Proteins that act as catalysts for chemical reactions.

Lysogenic/ Lytic- The phase found in some viruses in which the virus's genetic material becomes incorporated into the host cell and no new or new viruses are produced.

Virology 101Virology 101

Viral Hemorragic Fever (VHF)

5 distinct families, all RNA viruses

All enveloped in a lipid coating

Survival dependent on an animal or insect host, called the natural reservoir

Humans are not the natural reservoirCause severe hemorrhagic fever in humans and nonhuman primates.

Two members thus far identified: Marburgvirus and Ebolavirus.

Five species of Ebolavirus identified: Ta Forest (formerly Ivory Coast)SudanZaireReston Bundibugyo

FiloviridaeProduce mild to severe disease in human, in animals, and sometimes in both.

5 genera of viruses:OrthobunyavirusPhlebovirusNairovirusHantavirusTospovirus

Bunyaviridae

Cause widespread morbidity and mortality throughout the world.

Viruses include:Yellow FeverDengue FeverJapanese encephalitisWest Nile

Flaviviridae

ParamyxoviridaeCause a number of human and animal diseases.

The most recognized viruses :newcastle disease viruscanine distemperrinderpest

These viruses have been isolated from humans, bats, horses, and pigs.

Monocytes, macrophages, dendritic cells, liver cells, and endothelial cells are the primary target cells of MARV. Virus is present in many tissues including kidney, liver, spleen, lymph nodes, and blood, as well as most body secretions. The viruses enter the cells by endocytosis, or by phagocytosis in the case of macrophages.

Clinical Signs and Symptoms

Marburg hemorrhagic fever (MHF) and Ebola Viral Disease (EVD) are characterized by an paroxysmal onset of myalgia, pyrexia, and rigors. Gastralgia and/or nausea with diarrhea (haematochezia/melena) and/or emesis. Purpura is common. Hemoptysis and epistaxis are also frequent.

1) Endothelial damage mediated by both the virus and the up-regulation of toxic cytokines, which leads to extensive vascular leakage

2) Disseminated intravascular coagulation, which leads to severe thrombocytopenia.

1955 US Army AutopsyVascular permeabilityNecrosis Thrombocytopenia Liver Jejunum

Edema, Ecchymoses & Petachial Purpura

Haemorrhage in mucous membranes.

The Reservoir.

The natural reservoir host for MARV and EDV remains unknown. However, several outbreak-associated and outbreak-independent seroepidemiology field investigations, strongly suggest that fruit bats are important natural reservoir hosts for MARV and EDV.Ecology of Ebola

Zoonosis is the transfer of apathogenfrom one species to another.

Area:43,000 square miles (111,369 sq km); a little larger than TennesseePopulation:4,092,310 (July 2014 est.)Median age:17.9 yearsCapital:Monrovia (named for U.S. President James Monroe)Ethnic Groups:Kpelle 20.3%, Bassa 13.4%, Grebo 10%, Gio 8%, Mano 7.9%, Kru 6%, Lorma 5.1%, Kissi 4.8%, Gola 4.4%, other 20.1% (2008 Census)Religion:Christian 85.6%, Muslim 12.2%, Traditional 0.6%, other 1.6% (2008 Census)GDP:$2.898 billion (2013 est.)GDP per capita:$700 (2013 est.)Unemployment:85% (2003 est.)Literacy:definition:age 15 and over can read and writetotal population:60.8%male:64.8%female:56.8% (2010 est.)

Population:No. Physicians:Doctor/Patient Ratio:

6.496 M17,4691:3724.092 M1201:34,100

Patient Zero

CountryTotal CasesConfirmCasesTotal DeathsGuinea1199977739Liberia38349312069Sierra Leone24372179623Total747040873431West Africa collectively supplies two thirds of the world's cocoa crop, with Ivory Coast leading production at 1.22 milliontons.Ghana. Nigeria,Cameroon andTogo producing additional 1.41 million tons.Ebola is spread through direct contact (through broken skin or mucous membranes (eyes, nose, or mouth) with blood or body fluids.

This includes urine, saliva, sweat, feces, vomit, breast milk, and semen of a person who is sick with Ebola.

Also includes contaminated objects (i.e. needles, instruments, clothing) that has come in contact with blood or bodily fluid.

Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat.

There is no evidence that mosquitos or other insects can transmit Ebola virus.Transmission of VirusDirect ContactIndirect Contact

Diagnosis of Disease

Timeline of InfectionDiagnostic tests availableWithin a few days after symptoms begin

Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing

IgM ELISA

Polymerase chain reaction (PCR)

Virus isolation

Later in disease course or after recoveryIgM and IgG antibodies

Retrospectively in deceased patientsImmunohistochemistry testingPCRVirus isolationDiagnosis of Disease

Treatment of DiseasePalliative onlyProviding intravenous fluids (IV)Balancing electrolytes Maintaining oxygen status and blood pressureTreating opportunistic infections if they occur

1980s HIVTherapyH2O22014 EbolavirusTherapyHomeopathyBitter Kola/Kola Nut3 Large OnionsCoffeeSalt WaterBola buckets (bleach)Condense milk & holy waterRegular sex

ZMapp, being developed by Mapp Biopharmaceutical Inc., is an experimental treatment, for use with individuals infected with Ebola virus. It has not yet been tested in humans for safety or effectiveness. The product is a combination of three different monoclonal antibodies that bind to the protein of the Ebola virus.

There are currently no FDA approved vaccines for Ebola. The NIHs National Institute of Allergy and Infectious Diseases is working on developing an Ebola vaccine. NIH recently announced they are expediting their work and are launching phase 1 clinical trials of an Ebola vaccine.

NIH is also supporting the Crucell biopharmaceutical company in its development of an Ebola/Marburg vaccine as well as Profectus Biosciences in its development of an Ebola vaccine. Additionally, NIH and the Thomas Jefferson University are collaborating to develop a candidate Ebola vaccine based on the established rabies vaccine.

Therapies & Vaccines

To make ZMapp, the genes encoding for the antibodies were extracted from the hybridomas,genetically engineered to replace mouse components with human components, andtransfected into tobacco plants.ZMapp

A rapid and scalable process called "magnifection (magnificent transfection).

ZMapp

EndocytosisIs inhibited

CDC, WHO, UNICEF, Doctors Without Borders recommend:Keep borders openContinue flights in/out of affected areas

"This is what I have been trained for. It's like asking a fire fighter not to go into a burning house."

Dr. Suzanne Donovan

As a CDC EIS officer disease detective from 1990-1992, Dr. Frieden conducted many epidemiologic investigations, including outbreaks of measles, typhoid, cryptosporidium, and multidrug-resistant tuberculosis.Led New York Citys program that rapidly controlled tuberculosis, including reducing cases of multidrug-resistant tuberculosis by 80 percent.

While working in India for five years as a CDC assignee to the World Health Organization, he assisted with national tuberculosis control efforts. The program in India has treated more than 10 million patients and has saved more than three million lives.Donald Trump doesnt know jack shit about infectious diseases.At age 58, Mr. Trump married a 30 year old fashion model from Slovenia. The 50-pound orange Grand Marnier cake,with butter-cream filling, was covered with 3,000 roses.

In March 1990, Trump threatened to sue Janney Montgomery Scott, a stock brokerage firm, whose analysthad made negative comments on the financial prospects of his Taj Mahal casino.Tom FriedenDonald Trump

About 3.4 billion people half of the world's population are at risk of malaria. In 2012, there were about 207 million malaria cases (with an uncertainty range of 135 million to 287 million) and an estimated 627 000 malaria deaths

Millions of people fall ill every year and many die as a result of eating unsafe food. Diarrhreal diseases alone kill an estimated 1.5 million children annually, and most of these illnesses are attributed to contaminated food or water.

Schistosomiasis is an acute and chronic disease caused by parasitic worms. At least 249 million people required preventive treatment for schistosomiasis in 2012. The number of people reported to have been treated for schistosomiasis in 2012 was 42.1 million.

Sept 16 Obama pledges $1 billion and 3,000 US troops

Sept 16 UN says it will take $988 million over next 6 monthsto curb outbreak. Some 30% of funding has been received.

Sept 18 UN creates emergency mission to respond to crisis

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