Update on Ebola and Local Response

Ebola: Update and Local Response

Dr Nigel Calvert

November 2014

Topics

• Ebola

– History

– Virology

– Transmission and Natural History

– Clinical Features and Treatment

• Current Outbreak

– Latest situation in Africa

– Local implications and actions

Topics

• Ebola

– History

– Virology

– Transmission and Natural History

– Clinical Features and Treatment

• Current Outbreak

– Latest situation in Africa

– Local implications and actions

Ebola History

• First appeared in 1976

Ebola Past Outbreaks

• Prior to current outbreak:

– 34 outbreaks involving 2,101 patients and 1,548 deaths.

– Mostly Africa (2 in Russia)

– In Africa, animal outbreaks in primates have been noted which appear to decimate the populations

• Bats & Primates

• Main reservoir probably bats

The Ebola Virus

• RNA Virus

• Filovirus (like Marburg)

• Survival dependent on natural reservoir

– Thought to remain viable for several weeks on objects.

Ebola Virus Ecology

Ebola Virus Clinical Details

• Incubation period 2-21 days – most will develop symptoms

between 8-10 days after exposure.

• Initially mild similar flu-like illness

• Symptoms become progressively worse – Abdominal Pain – Diarrhoea – Vomiting – Bleeding

• Death is normally from shock usually preceded by multi-organ failure and bleeding.

Ebola Transmission 1

• ALL body fluids; blood, tears, saliva, sweat vomit, semen, diarrhoea.

• Viral load increases through the disease and hence infectivity increases.

• Low infective dose maybe as few as 10 organisms

Ebola Transmission 2

• Can be transmitted by contaminated objects

– Clothing

– Bedding

• Bodies after death are a high infection risk

• Sexually Transmitted

– After clinical disease the virus can be present in the semen for 7 weeks and infection has been documented after 61 days

Ebola Treatment

• Supportive Measures – Fluids

• Drug Treatments are in development – BCX 4430

• effective against Marburg and Ebola in animal models

• approaching phase 1 human trials

– ZMAPP • been used in the current

outbreak though still needs to go through human trails

Ebola vaccines

• Two vaccines being developed

– GSK (UK)

• undergoing phase 1 human trails

• may be ready for deployment in 2015.

– Johnson & Johnson (USA)

• > 12 months behind

Topics

• Ebola

– History

– Virology

– Transmission and Natural History

– Clinical Features and Treatment

• Current Outbreak

– Latest situation in Africa

– Local implications and actions

Current Outbreak of Ebola

Local Actions

• Viral Haemorrhagic Fever Contingency Group – DGRI

• Planning • Walk-through Exercise • Containment Facilities • Training • Personal Protective Equipment

– Public Health • Information to Primary care • Information to Education • Specific Page on Health Protection Website • Contact Tracing Arrangements

Immediate Actions

Case Study

• Gentleman from D&G returned from West Africa having been bitten by a snake – Receiving treatment in Glasgow

• Had visited several healthcare facilities where Ebola patients may have been treated – No definite history of direct contact

• Decision made with Glasgow to monitor as potential Ebola case – Daily contact for 21 days with Health Protection Team

• Temperature • Any relevant symptoms

Further Information

• www.dghps.org/home/ebola

• [email protected]

• 01387 272724