EBOLA VIRUS Presented by: Dr. Daniel Barbaro Infectious Disease

WHAT IS EBOLA?  Ebola virus disease (EVD), Ebola hemorrhagic fever (EHF) or simply Ebola is a disease of humans and other mammals caused by an ebolavirus.

Where does Ebola come from: Named after a river in the Congo where it was first found

EBOLA RIVER

EBOLA VIRUS  The first human outbreaks of Ebola on record occurred in Sudan and Zaire in 1976

And Now the US

Where is the Ebola virus found in nature • Natural reservoir of the Ebola virus remains unknown. • Zoonotic (animal-borne)  Fruit Bats  Fruit bats do not show any symptoms  Best candidate to be the reservoir

EBOLA VIRUS CYCLE

EBOLA VIRUS TRANSMISSION TO HUMANS  The link between human infection by the Ebola virus and their proximity to primates is clear. -Outbreaks occurred in countries that house 80 percent of the world’s remaining wild gorilla and chimpanzee populations. - The outbreaks coincided with the outbreaks in wild animals. - The same distinct viral strains were isolated in animal carcasses and in the bodies of those who handled those carcasses. - These outbreaks were preceded by an abnormally large death in wild Gorilla populations.

EBOLA SUBTYPES  Ebola-Zaire  Ebola-Sudan  Ebola-Ivory-Coast  Ebola-Bundibugyo  Ebola-Reston (REBOV)  All of these subtypes are found in Africa, except for EbolaReston, which is found in the Philippines. The Ebola-Reston virus is also the only subtype that will not cause illness in humans—it only affects animals.

MOLECULAR STRUCTURE  Characterization of the virus  Order: Mononegavirales  Family: Filoviridae  Genus: Ebolavirus

 Morphology under electron microscope

 filamentous, enveloped RNA virus  approx. 19 kb in length (1 kb = 1000 RNA bases/nucleotides) or 60-80 nm in diameter  single-stranded, linear, non-segmented  negative-sense RNA (encoded in a 3’ to 5’ direction)  appears to have “spikes” due to glycoprotein on outside membrane

EBOLA TRANSMISSION

 Because the natural reservoir host of Ebola viruses has not yet been identified, the manner in which the virus first appears in a human at the start of an outbreak is unknown. However, researchers believe that the first patient becomes infected through contact with an infected animal.

EBOLA TRANSMISSION  When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola  Objects (like needles and syringes) that have been contaminated with the virus  Infected animals

EBOLA TRANSMISSION  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 (wild animals hunted for food) and contact with infected bats.  There is no evidence that mosquitos or other insects can transmit Ebola virus.  Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.

EBOLA INCUBATION  The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patient becomes contagious once they begin to show symptoms. They are not contagious during the incubation period.  Ebola virus disease infections can only be confirmed through laboratory testing.

EBOLA DIAGNOSIS Timeline of Infection

Diagnostic tests available

Within 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 recovery

•IgM and IgG antibodies

Retrospectively in deceased patients

•Immunohistochemistry testing •PCR •Virus isolation

EBOLA EARLY SYMPTOMS During the incubation period, (2 to 21 days),symptoms include: • • • • • • • • • • •

Arthritic pain Backache (low-back pain) Chills Diarrhea Fatigue Fever Headache Malaise (general feeling of being unwell) Nausea Sore throat Vomiting

EBOLA LATE SYMPTOMS Late symptoms include: • Bleeding from eyes, ears, and nose • Bleeding from the mouth and rectum (gastrointestinal bleeding) • Depression • Eye inflammation (conjunctivitis) • Genital swelling (labia and scrotum) • Increased feeling of pain in skin • Rash over the entire body that often contains blood (hemorrhagic) • Roof of mouth looks red • Seizures, coma, delirium

EBOLA PREVENTION  There is no FDA-approved vaccine available for Ebola.  Wear protective clothing, including masks, gloves, gowns, and eye protection.  Practice proper infection control and sterilization measures.  Isolate patients with Ebola from other patients.  Avoid direct contact with the bodies of people who have died from Ebola.  Notify health officials if you have had direct contact with the blood or body fluids, such as but not limited to, feces, saliva, urine, vomit, and semen of a person who is sick with Ebola.  The virus can enter the body through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth

EBOLA PREVENTION  HEALTHCARE WORKERS treating patients with suspected or confirmed illness are at higher risk of infection than other groups. In addition to standard healthcare precautions, health workers should strictly apply recommended infection control measures to avoid exposure to infected blood, fluids, or contaminated environments or objects – such as a patient’s soiled linen or used needles.  They should use personal protection equipment such as individual gowns, gloves, masks and goggles or face shields.  They should not reuse protective equipment or clothing unless they have been properly disinfected.  They should change gloves between caring for each patient suspected of having Ebola.  Invasive procedures that can expose medical doctors, nurses and others to infection should be carried out under strict, safe conditions.  Infected patients should be kept separate from other patients and healthy people, as much as possible.

EBOLA PREVENTION  People are infectious as long as their blood and secretions contain the virus. For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home. When the medical professionals determine it is okay for the patient to return home, they are no longer infectious and cannot infect anyone else in their communities. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.

EBOLA TREATMENT  Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. THERE IS CURRENTLY NO SPECIFIC TREATMENT TO CURE THE DISEASE.  Some patients will recover with the appropriate medical care.  To help control further spread of the virus, people that are suspected or confirmed to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions.

EBOLA EXPERIMENTAL TREATMENTS AND VACCINES  Currently there are only experimental treatments for Ebola virus infection in the earliest stages of development.  ZMapp, being developed by Mapp Biopharmaceutical Inc., is an experimental treatment, for use with individuals infected with Ebola virus. The product is a combination of three different monoclonal antibodies that bind to the protein of the Ebola virus.  Two other companies, Tekmira and Biocryst Pharmaceuticals (BCX4430 is a broad-spectrum small molecule antiviral drug developed by BioCryst), receive funding from the Department of Defense's Defense Threat Reduction Agency and have therapeutic candidates for Ebola in early development.  Favipravir, an anti-viral drug approved in Japan for stockpiling against influenza pandemics, appears to be useful in a mouse model of Ebola.

EBOLA VACCINES  There are currently no FDA approved vaccines for Ebola  On August 28, 2014, NIH announced that initial human testing of an investigational vaccine to prevent Ebola virus disease will begin by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.  The early-stage trial will begin initial human testing of a vaccine co-developed by NIAID and GlaxoSmithKline (GSK) and will evaluate the experimental vaccine’s safety and ability to generate an immune system response in healthy adults. Testing will take place at the NIH Clinical Center in Bethesda, Maryland.  The Department of Defense is working with a company called Newlink to develop an Ebola vaccine candidate.

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