Ebola virus: Difference between revisions

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==Background==
  
==Background==
   
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=== Microbiology ===
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===Microbiology===
   
 
*Negative-sense single-stranded RNA virus in the [[Filoviridae]] family
  
*Negative-sense single-stranded RNA virus in the [[Filoviridae]] family
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**TaΓ― Forest (or Cote d'Ivoire) ebolavirus (TAFV)
  
**TaΓ― Forest (or Cote d'Ivoire) ebolavirus (TAFV)
   
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=== Epidemiology ===
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===Epidemiology===
   
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* Essentially located exclusively in west Africa
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*Essentially located exclusively in west Africa
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* Outbreaks occur where there is food insecurity (with resultant hunting for bush meat), increased population density, and insufficient public health infrastructure
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*Outbreaks occur where there is food insecurity (with resultant hunting for bush meat), increased population density, and insufficient public health infrastructure
   
 
==Clinical Manifestations==
  
==Clinical Manifestations==
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*Hiccups associated with increased mortality
  
*Hiccups associated with increased mortality
   
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== Diagnosis ==
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==Diagnosis==
   
βˆ’
* Ensure to notify the lab before sending samples, and contact Public Health for instructions
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*Ensure to notify the lab before sending samples, and contact Public Health for instructions
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** [[Biosafety risk groups|Biosafety level 4 agent]]
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**[[Biosafety risk groups|Biosafety level 4 agent]]
βˆ’
* qPCR at the Public Health Laboratory Ontario, but only for Zaire ebolavirus
 +
*qPCR at the Public Health Laboratory Ontario, but only for Zaire ebolavirus
βˆ’
* Canada's National Microbiology Laboratory does RT-PCR, viral isolation, and serology
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*Canada's National Microbiology Laboratory does RT-PCR, viral isolation, and serology
   
βˆ’
== Management ==
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==Management==
   
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* Supportive care alone can decrease mortality to 20-30%
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*Supportive care alone can decrease mortality to 20-30%
βˆ’
* Monoclonal antibodies
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*Monoclonal antibodies
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** REGN-EB3 (6% mortality)
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**REGN-EB3 (6% mortality)
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** mAb-114 (11% mortality)
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**mAb-114 (11% mortality)
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** Zmapp (24% mortality)
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**Zmapp (24% mortality)
βˆ’
* Medications
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*Medications
βˆ’
** [[Remdesivir]] (33% mortality)
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**[[Remdesivir]] (33% mortality)
   
βˆ’
== Prevention ==
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==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
  
  ⚫
*Vaccination with a recombinant vesicular stomatitis virus that has its glycoprotein replaced by Ebola virus glycoprotein
⚫
** Efficacy 95-100%
  
  ⚫
**Used in large West African and DRC outbreaks with ring vaccination
⚫
** >100,000 doses give
  
  ⚫
**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]]

Revision as of 09:42, 28 August 2020

Background

Microbiology

  • Negative-sense single-stranded RNA virus in the Filoviridae family
  • The ebolavirus genus includes five species:
    • Zaire ebolavirus (EBOV), the most common
    • Bundibugyo ebolavirus (BDBV)
    • Reston ebolavirus (RESTV)
    • Sudan ebolavirus (SUDV)
    • TaΓ― 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

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
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