Ebola virus: Difference between revisions

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
- Biosafety level 4 agent
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
- 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

@@ Line 1: / Line 1: @@
-==Microbiology==
+==Background==
+===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]]
 *The ebolavirus genus includes five species:
 **Zaire ebolavirus (EBOV), the most common
 **Bundibugyo ebolavirus (BDBV)
-**Reston ebolavirus (RESTV)
+**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 [[Incubation period range::2 to 21 days]] (generally [[Usual incubation period::3 to 13 days]])
-*Fever, fatigue, myalgias, weakness, and dizziness
+*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
+**[[Biosafety risk groups|Biosafety level 4 agent]]
+*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
+**[[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
-=== Prognosis and Complications ===
+===Infection Prevention and Control===
+*Isolate patient
-* 33 to 75% mortality, depending mostly on supportive care
+*Droplet precautions and face protection within 1 meter of patient
+*Limit hospital staff who have contact
 [[Category:Filoviridae]]