EBOLAWhat You Need To

Know

By

Barry Miskin, MD, FACS

Ebola VirusNamed After Ebola River In Africa

That Runs Through Zaire & The Congo

Cases of Ebola 1979 to 2008.

Ebola 2014

Only 7 Cases In US

Transmitted By Food

Transmission

• Nearly two thirds of the cases of Ebola infections in Guinea during the 2014 outbreak contracted via unprotected contact with infected corpses during "Guinean burial rituals”

• No Air Transmission

• infected fruit bats drop partially eaten fruits or fruit pulp, then land mammals such as gorillas and duikersmay feed on these fallen fruits.

• This chain of events forms indirect means of transmission from the natural host species to other animal species viral shedding in the saliva of fruit bats.

Cane Rat, Giant Pouched Rat, Red-Flanked Duiker

Transmission

• Human-to-human transmission occurs only via direct contact with blood or body fluid from an infected person (including embalming of an infected dead body)

• Contact objects contaminated by the virus, needles & syringes

• Other body fluids that transmit ebolaviruses saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen

• Entry points include the nose, mouth, eyes, or open wounds, cuts and abrasions.

• Transmission from other animals to humans occurs only via contact with, or consumption of, an infected mammal, such as a fruit bat, or ape

Virus Can Live On Contaminated Surfaces for Up to 3 Hours

CDC Worker Incinerates Medical WasteTo Prevent Spread

How Does It Spread

• Contact With Blood or Other Bodily Fluids of Infected Humans Or Other Mammals

• Fruit Bats May Spread Ebola Without Having Symptoms

• Male Survivors Can Transmit Ebola Through Semen for up to 2 Months

Biosafety Level 4 Hazmat SuitProtects

Mortality Rate 25-90%, Avg 50%Best To Dispose of Bodies Quickly

Symptoms

• Starts 2 days to 3 Weeks after Exposure

• Fever

• Sore Throat

• Muscle Pain

• Headaches

Next Stage

• Nausea

• Vomiting

• Diarrhea

• Rash

• Progress to Uncontrolled Hemorrhage 5-7 days after first Symptoms

• Kidney & Liver Failure 7-16 days if no Recovery

Symptoms 2 Days-3 Weeks

Diagnosis

• R/O Maleria & Cholera & other Hemorrhagic Fevers

• Blood Samples Test for Viral Ab, Viral RNA, or Virus itself

Diagnostic Test Blood Viral Ab, Viral RNA, Ebola Virus

Ebola Outbreak in Gulu Municipal Hospital, Uganda, Tx Supportive

Treatment

• No Specific Treatment

• Oral or IV Hydration

• Supportive Care Improves Recovery

• No Vaccine

As of 10/10/2014 8,376 Cases Resulting in 4,024 Deaths Worldwide

RNA Virus Infects Cells

Education for Prevention

Prevention

• Decrease Spread from Infected Animal to Human by Handling Potentially infected Meat with Protective Gear and Fully Cooking It

• Proper Protective Clothing & Washing Hands around Potentially Infected Patients

• Specimens of Bodily Fluids & Blood Handled with special precautions

Mass Screening

Fever Scan At Airports

Prevention

• Rapid Detection & Contact Tracing

• Quick Access to Lab Services

• Proper Management of Those Infected

• Proper Disposal of Dead through Cremation or Burial

Prognosis

• High Risk of Death 25-90% of those infected

• Avg 50% die from contracting Ebola

• 1976 – 2013 first detected 1716 cases reported

• As of 10 October 2014, 8,376 suspected cases resulting in the deaths of 4,024 have been reported

Precautions

• if caring for a symptomatic suspect/confirmed case Gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask

• If copious amounts of blood, other body fluids, vomit, or feces present in the environment: double gloving, disposable shoe covers, and leg coverings

• if monitoring an asymptomatic contact Gloves (as long as there is no potential for exposure to blood/body fluids)

• Bring extra PPE when monitoring contacts in case contact becomes symptomatic

Exposure Risk Levels

• High risk exposures: • –Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD

patient • –Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without

appropriate personal protective equipment (PPE) • –Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard

biosafety precautions • –Direct contact with decedent remains without appropriate PPE in a country where an EVD

outbreak is occurring • Low risk exposures: • –Household contact with an EVD patient • –Other close contact with EVD patients in health care facilities or community settings • –Brief interactions, such as walking by a person or moving through a hospital, do not constitute

close contact • No known exposure: • –Having been in a country in which an EVD outbreak occurred within the past 21 days and having

had no high or low risk exposures

Take Home Message

• Only Get Ebola From Touching Bodily Fluids of Person Who is Sick With or Has Died From Ebola

• Or From Exposure to Contaminated Objects, Such As Needles

• Ebola Poses No Significant Risk In US

Depends On What You See

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