Ebola virus: Difference between revisions

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==Background==
= Microbiology =
 
   
 
===Microbiology===
* Negative-sense single-stranded RNA virus in the Filoviridae family
 
   
 
*Negative-sense single-stranded RNA virus in the [[Filoviridae]] family, related to [[Marburg virus]] and [[Cueva virus]]
= Clinical Presentation =
 
  +
*The ebolavirus genus includes five species:
  +
**Zaire ebolavirus (EBOV), the most common
  +
**Bundibugyo ebolavirus (BDBV)
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**Reston ebolavirus (RESTV), which does not cause disease in humans
  +
**Sudan ebolavirus (SUDV)
  +
**Taï Forest (or Cote d'Ivoire) ebolavirus (TAFV)
   
  +
===Epidemiology===
* Incubation period 2 to 21 days (generally 3 to 13 days)
 
  +
* Fever, fatigue, myalgias, weakness, and dizziness
 
  +
*Essentially located exclusively in west Africa
* EBOV can persist after resolution of symptoms in privileged sites: the eyes, CNS, male reproductive tract, and mammary glands
 
  +
*Outbreaks occur where there is food insecurity (with resultant hunting for bush meat), increased population density, and insufficient public health infrastructure
* Relapse can occur as uveitis or meningitis
 
  +
*Human-to-human transmission occurs via exposure to contaminated blood or fluids, including providing care to infected family or patient and preparing an infected body for funeral
  +
*Mainly infectious during symptoms, which corresponds to viremia
  +
 
==Clinical Manifestations==
  +
 
*Incubation period [[Incubation period range::2 to 21 days]] (generally [[Usual incubation period::3 to 13 days]])
 
*Initially starts as a non-specific influenza-like illness with fever, fatigue, myalgias, weakness, and dizziness
  +
*Followed by multiorgan involvement and hemorrhagic manifestations (30-50%)
 
*EBOV can persist after resolution of symptoms in privileged sites: the eyes, CNS, male reproductive tract, and mammary glands
 
*Relapse can occur as uveitis or meningitis
  +
*Death usually within 6 to 16 days of symptom onset
  +
  +
===Prognosis and Complications===
  +
  +
*40 to 70% mortality, depending mostly on supportive care
  +
*Hiccups associated with increased mortality
  +
  +
==Diagnosis==
  +
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*Ensure to notify the lab before sending samples, and contact Public Health for instructions
  +
**[[Biosafety risk groups|Biosafety level 4 agent]]
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*qPCR at the Public Health Laboratory Ontario, but only for Zaire ebolavirus
  +
*Canada's National Microbiology Laboratory does RT-PCR, viral isolation, and serology
  +
  +
==Management==
  +
  +
*Supportive care alone can decrease mortality to 20-30%
  +
*Monoclonal antibodies
  +
**REGN-EB3 (6% mortality)
  +
**mAb-114 (11% mortality)
  +
**Zmapp (24% mortality)
  +
*Medications
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**[[Remdesivir]] (33% mortality)
  +
  +
==Prevention==
  +
  +
===Vaccination===
  +
  +
*Vaccination with a recombinant vesicular stomatitis virus that has its glycoprotein replaced by Ebola virus glycoprotein
  +
**Used in large West African and DRC outbreaks with ring vaccination
  +
**Efficacy 95-100%
  +
**>100,000 doses give
  +
  +
===Infection Prevention and Control===
  +
  +
*Isolate patient
  +
*Droplet precautions and face protection within 1 meter of patient
  +
*Limit hospital staff who have contact
   
 
[[Category:Filoviridae]]
 
[[Category:Filoviridae]]

Latest revision as of 08:53, 29 August 2020

Background

Microbiology

  • Negative-sense single-stranded RNA virus in the Filoviridae family, related to Marburg virus and Cueva virus
  • The ebolavirus genus includes five species:
    • Zaire ebolavirus (EBOV), the most common
    • Bundibugyo ebolavirus (BDBV)
    • Reston ebolavirus (RESTV), which does not cause disease in humans
    • Sudan ebolavirus (SUDV)
    • Taï Forest (or Cote d'Ivoire) ebolavirus (TAFV)

Epidemiology

  • Essentially located exclusively in west Africa
  • Outbreaks occur where there is food insecurity (with resultant hunting for bush meat), increased population density, and insufficient public health infrastructure
  • Human-to-human transmission occurs via exposure to contaminated blood or fluids, including providing care to infected family or patient and preparing an infected body for funeral
  • Mainly infectious during symptoms, which corresponds to viremia

Clinical Manifestations

  • Incubation period 2 to 21 days (generally 3 to 13 days)
  • Initially starts as a non-specific influenza-like illness with fever, fatigue, myalgias, weakness, and dizziness
  • Followed by multiorgan involvement and hemorrhagic manifestations (30-50%)
  • EBOV can persist after resolution of symptoms in privileged sites: the eyes, CNS, male reproductive tract, and mammary glands
  • Relapse can occur as uveitis or meningitis
  • Death usually within 6 to 16 days of symptom onset

Prognosis and Complications

  • 40 to 70% mortality, depending mostly on supportive care
  • Hiccups associated with increased mortality

Diagnosis

  • Ensure to notify the lab before sending samples, and contact Public Health for instructions
  • qPCR at the Public Health Laboratory Ontario, but only for Zaire ebolavirus
  • Canada's National Microbiology Laboratory does RT-PCR, viral isolation, and serology

Management

  • Supportive care alone can decrease mortality to 20-30%
  • Monoclonal antibodies
    • REGN-EB3 (6% mortality)
    • mAb-114 (11% mortality)
    • Zmapp (24% mortality)
  • Medications

Prevention

Vaccination

  • Vaccination with a recombinant vesicular stomatitis virus that has its glycoprotein replaced by Ebola virus glycoprotein
    • Used in large West African and DRC outbreaks with ring vaccination
    • Efficacy 95-100%
    • >100,000 doses give

Infection Prevention and Control

  • Isolate patient
  • Droplet precautions and face protection within 1 meter of patient
  • Limit hospital staff who have contact