PREVENTION OF EBOLAVIRUS INFECTION

& THE ASSOCIATED CHALLENGES

Dr.Chandan

House surgeon,

KIMS.

Guide:

Dr.Laxmikant Lokare

Associate Professor,

Dept. of Community Medicine,

KIMS.

PEOPLE AT RISK

Healthcare workers.

Contacts of Ebola patients.

People coming in contact with infected

wildlife.

CASE DEFINITIONS

SUSPECTED CASE:

Any person, alive or dead, suffering or having suffered from a

sudden onset of high fever and having

had contact with:

- a suspected, probable or confirmed case of Ebola

- a dead or sick animal.

OR: any person with inexplicable bleeding.

OR: any sudden, inexplicable death.

PROBABLE CASE:

Any suspected case evaluated by a clinician.

Instructions when a suspected case has

been identified:• Report the case to the surveillance team.

• After obtaining express consent, collect a sample.

• Fill in a case notification form.

• Draw up a list of contacts of the suspected case.

LABORATORY TESTS

Timeline of Infection Diagnostic tests available

Within a few days after symptoms begin •Antigen-capture ELISA

•Polymerase chain reaction (PCR)

•Virus isolation

•IgM ELISA

Later in disease course or after recovery •IgM and IgG antibodies

Retrospectively in deceased patients •Immunohistochemistry testing

•PCR

•Virus isolation

SCREENING DURING

AIR TRAVEL

The DGCA has issued the following directives to all airlines

the operating on international routes in India-

• In flight announcement for self-reporting.

• Travellers on flights to be given the health-form.

• To keep a record of all passengers or families who are

returning to India after staying or visiting the West

African countries.

• The details of the passengers boarding from affected

countries must be sent in advance.

THERMAL SCANNERS

• The union health minister on Tuesday said

that 2 thermal scanners have been

installed in every International airport in

India.

• They have started functioning in the

country since yesterday.

ISOLATION &

QUARANTINE

• Isolation separates sick people with a

contagious disease from people who are not

sick.

• Quarantine separates and restricts the

movement of people who were exposed to a

contagious disease to see if they become sick.

ISOLATION

PROCEDURES

Isolation area must consist of :

1)An isolated toilet 2)Adequate ventilation 3)Screened

windows

A plan of the isolation area

Gather Recommended SuppliesBed and mattress, Plastic sheeting, thermometers,

Covered container , Screens or other barriers

Plan disinfection for contaminated items

using

1)Ordinary Household Bleach 2)Soap and Clean Water

3)Sterilization

Set Up Changing Rooms for patient-care staff

Place Security Barrier Around Isolation Area

PRECAUTIONS DURING

TREATMENT

Restrict all non essential staff.

Limit the number of visitors.

Ensure that all staff and visitors correctly use personal

protective equipment (PPE).

Hand hygiene.

Limit the use of needles and other sharp objects.

Take the patients out of their rooms if they are free of

virus, or for essential, life-saving tests ONLY.

Cleaning of the environment and patient care equipment.

CONTACT TRACING

Contact tracing means finding everyone who

comes in contact with an ebola patient.

The CDC quotes contact tracing as an

effective method in controlling the current

outbreak.

CONTACT TRACING

PRECAUTIONS FOR

HEALTHCARE WORKERS• Wear protective clothing, including masks, gloves,

gowns, and eye protection.

• Practice proper infection control and sterilization

measures.

• Hand hygiene.

• Avoid direct contact with the bodies of Ebola victims.

• Handling the bodies of ebola victims must be done by

trained personnel only and with PPE.

WHO-RECOMMENDED

HANDRUB FORMULATIONS

FORMULATION 1

Ethanol 80% (v/v)

Glycerol 1.45% (v/v)

Hydrogen peroxide 0.125% (v/v)

FORMULATION 2:

Isopropyl alcohol 75%(v/v)

Glycerol 1.45% (v/v)

Hydrogen peroxide 0.125% (v/v)

WASTE MANAGEMENT

PROCEDURES• Waste segregation.

• Sharp objects that has been in contact with blood or body

fluids should be placed inside puncture resistant waste

containers. These should be located as close as practical to

the patient care area where the items are used.

• Collect all solid, non-sharp, infectious waste using leak-proof

waste bags and covered bins. Bins should never be carried

against the body.

• Waste should be placed in a designated pit of appropriate

depth (e.g. 2 meters or about 7 feet) and filled . After each

waste load, the waste should be covered with a layer of soil

10 –15 cm deep.

• An incinerator may be used for short periods during an

outbreak to destroy solid waste. However, it is essential to

ensure that total incineration has taken place.

• Placenta and anatomical samples should be buried in a

separate pit.

• The area designated for the final treatment and disposal of

waste should have controlled access to prevent entry by

animals, untrained personnel or children.

• Waste, such as faeces, urine and vomit, and liquid waste from

washing, can be disposed of in the sanitary sewer or pit

latrine. No further treatment is necessary

VACCINES

Recombinant vesicular stomatitis

virus(rVSV-ZEBOV) encoding ebolavirus

glycoproteins.

Developed by the Public Health Agency of

Canada in Winnipeg.

Another vaccine developed by

GlaxoSmithKline in collaboration with the

US National Institute of Allergy and

Infectious Diseases is cAd3-ZEBOV.

It uses a chimpanzee-derived adenovirus

vector with an Ebola virus gene inserted.

POST EXPOSURE

PROPHYLAXIS

Post-exposures prophylaxis / treatment

• Interferon alpha

• ZMapp - “Secret Serum”

Three monoclonal antibodies against parts of

the glycoprotein

Manufactured in tobacco plant.

Suppresses viraemia and viral spread

Effective in non-human primates – 3 doses

starting on days 3 to 5

TKM – Ebola developed by Tekmira Pharmaceuticals Corp.

• Small interfering RNAs

• Zaire Ebola L polymerase, Zaire Ebola membrane-

associated protein (VP24), and Zaire Ebola polymerase

complex protein (VP35)

• Inhibits the replication of the virus

• Post-exposure prophylaxis in non-human primates given

in multiple doses (30 minutes after infection and then

either

day 1, 3 and 5 or daily for 6 days)

• Tekmira has commenced clinical trials in January 2014.

CHALLENGES IN THE

PREVENTION• Health systems in the affected countries

are not highly functional.

• Lack of understanding about the disease

and receptivity to control measures on the

part of some of the affected populations.

• A large number of international travellers.

• Lack of cooperation between the countries

and the various health organizations.

• Poor economy of the countries.

• TECHNICAL CHALLENGES

• The virus and disease are incompletely

understood.

• Difficulties in research activities due to

high risk to those involved.

• No specific treatment is made available.

• No effective vaccine is made available.

REFERENCES

• Park’s Textbook Of Preventive And Social

Medicine e21 K.Park

• The WHO website http://www.who.int

• The CDC website http://www.cdc.gov

• Wikipedia- http://www.wikipedia.org

• The DGCA http://dgca.nic.in

• The Hindustan Times