EbolaEbolaVirusIntroductionFirstappearedinAfrica1976“AfricanHemorrhagicFever”

acute,mostlyfataldiseasecausesbloodvessel“bursting”systemic(allorgans/tissues)humansandnonhumanprimatesExcluding‘2000outbreak1,500casesover1,000deaths

EbolaTaxonomyScientificClassification

Order:MononegaviralesFamily:FiloviridaeGenus:EbolalikevirusesSpecies:Ebola

Subtypes

Ebola-Zaire,Ebola-Sudan,Ebola-IvoryCoastdiseaseinhumansEbola-Reston

diseaseinnonhumanprimatesCopyrightedDr.Fre:derickA.Murphy,D.V.M.,Ph.D.1976.Filoviridaeor

“Filoviruses”MostmysteriousvirusgroupPathogenesispoorlyunderstoodEbolanaturalhistory/reservoirsunknownexistthroughouttheworldendemictoAfricafilamentousssRNA-(antisense)virusesImagecourtesyoftheCentersforDiseaseControl

埃博拉病毒埃博拉病毒結構示意圖EbolaPathogenesisEntersBloodstreamskin,membranes,openwoundsCellLeveldockswithcellmembraneViralRNAreleasedintocytoplasmproductionnewviralproteins/geneticmaterialNewviralgenomesrapidlycoatedinproteincreatecoresCopyright:RussellKightleyMedia,AustraliaEbolaPathogenesis,contViralcoresstackupincellmigratetothecellsurfaceproducetrans-membraneproteinspushthroughcellsurfacebecomeenvelopedbycellmembranessRNA-GenomeMutations

capableofrapidmutationveryadaptabletoevadehostdefensesandenvironmentalchangeTheoryvirusevolvedtooccupyspecialnichesinthewildSymptomsandDiagnosticTestsEarlysymptomsmuscleaches,fever,vomitingredeyes,skinrash,diarrhea,stomachpainAcutesymptoms

bleeding/hemorrhagingfromskin,orifices,internalorgansEarlyDiagnosisverydifficultsigns&symptomsverysimilartootherinfectionsLaboratoryTest

PCRdetectionELISA(enzyme-linkedimmuno-absorbant)assaySymptomsofEbolaInitialsymptomsarenonspecific-mayincludefever,chills,myalgias,andmalaise.Patientscanprogresstodevelopgastrointestinalsymptoms:severewaterydiarrhea,nausea,vomiting,abdominalpainOthersymptoms:chestpain,shortnessofbreath,headacheorconfusion,conjunctivalinjection,hiccups,seizures,andcerebraledemaBleedingnotuniversallypresentbutcanmanifestlateraspetechiae,ecchymosis/bruising,oroozing.Frankhemorrhagelesscommon.Somedevelopdiffuseerythematousmaculopapularrashthatcandesquamate.Mostcommonsymptomsreportedduringcurrentoutbreak:fever(87%)fatigue(76%)vomiting(68%)diarrhea(66%)lossofappetite(65%)Patientswithfataldiseasedevelopmoresevereclinicalsignsearlyduringinfectionanddiebetweendays6-16ofcomplications(meanof7.5days).Innon-fatalcases,patientsmayhavefeverforseveraldaysandimprove,aroundday6.ThecasefatalityproportioninWestAfricaisabout71%Source:CentersforDiseaseControlandPrevention./vhf/ebola/hcp/clinician-information-us-healthcare-settings.htmlAccessedOct.14,2014EBOLAHAEMORRHAGICFEVERINSUDAN,1976BulletinoftheWorldHealthOrganizationJID2011:204(Suppl3)dKortepeteretalDiagnosisofEbolaTimelineofInfectionDiagnostictestsavailableWithinafewdaysaftersymptomsbeginAntigen-captureenzyme-linkedimmunosorbentassay(ELISA)testingIgMELISAPolymerasechainreaction(PCR)VirusisolationLaterindiseasecourseorafterrecoveryIgMandIgGantibodiesRetrospectivelyindeceasedpatientsImmunohistochemistrytestingPCRVirusisolationDiagnosingEbolacanbedifficultatfirstsinceearlysymptoms,suchasfever,arenonspecifictoEbolainfection.However,ifapersonhastheearlysymptomsandhashadcontactwithEbolatheyshouldbeisolatedandpublichealthprofessionalsnotified.Samplesfromthepatientcanthenbecollectedandtestedtoconfirminfection.Source:CentersforDiseaseControlandPrevention/vhf/ebola/diagnosis/index.htmlAccessedOct.14,2014TreatmentNoStandardTreatmentavailablePatientsreceivesupportivetherapytreatingcomplicatinginfectionsbalancingpatient’sfluidsandelectrolytesmaintainingoxygenstatusandbloodpressureInfection-controlMeasurescompleteequipmentandareasterilizationPreventionNovaccines!PatientsareisolatedMedicalStaffTrainingwesternsanitationpracticesintakecareduringstayafterpatientdiesPreventionAfterDeathViruscontagiousinfluidsfordaysBurialuseextremecautionhandlingandtransportculturalpractices/religiousbeliefincinerateallwaste!!!!Source:/vhf/ebola/pdf/ppe-poster.pdfAccessedOct.14,2014FormoredetailonPPEforHealthCareWorkers,pleasevisit:/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

EbolaEpidemiologyReservoirsinNaturelargelyunknownpossiblyinfectedanimals(primates?)EbolaEpidemiologyTransmission

directcontactblood/secretionsofinfectedpersonpossibleairborne

(Restonprimatefacility)Onsetofillnessabruptincubationperiod:2to21daysinfectionsareacuteandmostlydeadlyEbolaEpidemiologyTransmission

directcontactblood/secretionsofinfectedpersonpossibleairborne

(Restonprimatefacility)Onsetofillnessabruptincubationperiod:2to21daysinfectionsareacuteandmostlydeadlyLatestMorbidityandMortalityReportsEbola-RestonVirusInfectionAmongQuarantinedNonhumanPrimates--Texas,1996

reportdescribesdeathandbloodtestingofcynomolgusmonkeyimportedfromthePhilippinesheldinaprivatequarantinefacilityinTexasOutbreakofEbolaHemorrhagicFever---Uganda,August2000--January2001reportdescribessurveillanceandcontrolactivitiesrelatedtotheEHFoutbreakpresentspreliminaryclinicalandepidemiologicfindingsCurrentBasicResearchTheassemblyofEbolavirusnucleocapsidrequiresvirion-associatedproteins35and24andposttranslationalmodificationofnucleoprotein

ReportdescribesdistinctVP35andVP24proteinsmechanismof

regulationforfilovirusassemblysuggestsnewapproachesforviraltherapiesandvaccinesforEbola

andrelatedvirusesDetectionofantibodiesagainstthefoursubtypesofEbolavirusinserafromanyspeciesusinganovelantibody-phageindicatorassayassessesthepresenceofspecificantibodiesinserum

describesdevelopmentofanovelassayforthedetectionofseroconversionirrespectiveofEbolavirussubtypeoranimalspeciesReferencesReemergenceofEbolaVirusinAfrica;AnthonySanchezetal,EIDVolume1*Number3July-September1995/ncidod/EID/vol1no3/sanchez.htmViralHemorrhagicFever,Healthlink,MedicalCollegeofWisconsin,2000

/article/955159073.htmlIsolationandPhylogeneticCharacterizationofEbolaVirusesCausingDifferentOutbreaksinGabon EmergingInfectiousDiseases,NationalCenterforInfectiousDiseases,CentersforDiseaseControlandPrevention,February5,1997

/ncidod/EID/vol3no1/courbot2.htmHemorrhagicfevers;JuliaBarrett,GaleEncyclopediaofMedicine,GaleResearch,1999

/cf_dls/g2601/0006/2601000652/p1/article.jhtml

KeyIssuesinthePreventionandControlofViralHemorrhagicFeversClarenceJ.Peters,MD,SpecialPathogensBranch/DivisionofViralandRickettsialDiseases,NationalCenterforInfectiousDiseases/CentersforDiseaseControlandPrevention,1997

/od/ohs/sympsium/symp43.htmScientificStockImagesLibrary;RussellKightleyMedia,Australia

.au/imagelibrary/index.htmlOutbreakofEbolaHemorrhagicFever---Uganda,August2000--January2001, MorbidityandMortalityWeeklyReport,Vol50,No05;73,0