Running head: EBOLA PICO

Ebola PICO Desiree Graham Herzing University

EBOLA PICO The first strain of Ebola, Ebola Zaire, was first discovered in 1976. Since then 4 other strains

of Ebola have identified: Sudan, Cote dIvoire, Reston and the latest strain Bundibugyo in 2007. 2322 cases of Ebola have been reported since its discovery in 1976 with a fatality rate of 90 percent during some outbreaks. This has led Ebola to be classified as a Class A bioterrorist threat, and also a Level 4 biological hazard by the CDC. Ebola Virus Population I. There is no easily identifiable high-risk population for the Ebola virus due to the sporadic nature of the outbreaks. A. Almost all human cases of Ebola are due to emergence or reemergence of the virus in in Equatorial Africa. B. Healthcare workers are also at high risk for infection as up to1/4th of infected patients have been healthcare workers who contracted Ebola while treating patients during outbreaks. C. Regions that the outbreaks have been identified are: Gabon, Republic of the Congo, Sudan and Uganda. D. There are two current outbreaks of Ebola in Uganda and the Democratic Republic of Congo Age & Sex II. In the largest outbreak recorded so far all ages and both sexes are infected with the Ebola Virus. A. Females were predominated infected, mainly in the age group of 5-14 and 15-29. B. Infected pregnant women have an increased risk of miscarriage. C. Clinical findings also indicate a high fatality rate for the children of infected mothers.

Interventions

EBOLA PICO III. Despite two decades of research, researchers are still unclear about the exact virulence factors and host response. Therefor there are not any developed treatment methods or vaccines for the Ebola Virus. A. Due to the limited nature of the outbreaks (or due to under reporting of infected patients) research of disease specific evidenced based clinical interventions has been limited. B. Due to ethical considerations and the high risk of death associated with the Ebola Virus, experimentation on treatment options are not considered ethical. C. Once case of hemorrhagic fever in Europe had only a fatality rate of 22% when patients have Intensive Care. This is lead to the current speculation that fatality rates can be lowered with facilities that can fully accommodate intensive care units.

IV.

Recommended Guidelines for Treatment A. In developing countries present treatment methods for Ebola include, isolation, malaria treatment, broad spectrum antibiotics and antipyretics, IV fluids, and analgesics. In developed healthcare systems treatment methods include isolation and maintenance of effective blood volume and electrolyte balance. Management should also include interventions for shock, renal failure, coagulation disorders, organ failure, and secondary bacterial infections.

B.

Comparisons

V.

Finding the source of Ebola for prevention as the best course of action to prevent outbreaks vs. focusing on vaccination protection for at risk population. Prevention A. Current research suggests that bats and eating infected meat are the primary source of infection in humans. B. Ebola is thought to present with a classic zoonosis, with persistence of the Ebola Virus found in reservoirs of bats and apes.

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4 C. Studies however are still being conducted on how this potential reservoir spreads to humans, as humans have become infected without ingesting infected meat. D. Bats are hunted and used for food in several areas of Africa, preventative efforts to stop people from using bats as a source of meat could result in cultural and nutritional issues.

Vaccination A. Due to the potential of the use of Ebola as a biological weapon, vaccine protection is considered for military, healthcare workers, and from possible lab exposure. B. Due to costs it may be difficult to treat all people that may potentially come in contact with the virus in Africa. C. Clinical trials of an Ebola vaccine is only in phase 1 of trials, with acute toxicity reported when administered in high doses in pre-clinical trials. Outcome

VI.

In order to prevent Ebola outbreaks from occurring, to lower the fatality rates of those infected, and to prevent Ebola from becoming a worldwide epidemic; multiple efforts on several fronts need to be addressed. A. Evidenced based preventive methods to avoid infection of the Ebola virus needs to be identified and addressed. 1. The exact reservoir of the virus needs to be identified. Since Ebola has also been found in other animals, notably the Reston Ebola in pigs, other reservoir need to also be considered. 2. An effective vaccine needs to be pass clinical trials to be used effectively for all at risk populations. B. Fatality rates for those infected need to be lowered as much as possible form the 90% fatality rate that is possible. 1. More research needs to be conducted on the exact mechanism that protects patients from a fatal response of the disease.

EBOLA PICO 2. Clinical treatments need to be tested and developed, with certain drugs such as Ribavirin have already been shown to be ineffective, but other approaches such as treatment with protein C have shown to be effective.

C. The development of a vaccine is thought to be the best preventative of a worldwide epidemic of Ebola, and to prevent its usage as a biological weapon. 1. A vaccine needs to be a multivalent to provide the best protection against the various types of Ebola virus.

The Ebola virus is a fast acting often fatal virus that needs more research and clinical study analysis. The best approach to eradicate Ebola as a risk to global health would be an approach that addresses prevention, effective treatment options and a vaccine for protection. With Ebola considered a virus that could be used as a biologic weapon, its impact on global health cannot be dismissed. Although outbreaks generally occur in less populated rural areas, with the discovery of Ebola Reston in Maryland in 1989, this underscores the possibility of the virus reaching more populated environments.

EBOLA PICO References

Fieldmann, Heinz, and Thomas W. Geisbert. "Ebola Haemorrhagic Fever." The Lancet 377 (2011): 849-62. Web.

"Known Cases of Outbreaks of Ebola Fever." CDC. N.p., n.d. Web. 14 Nov. 2013. <http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/ebolatable.htm>.

Sullivan, N. J., Martin, J. E., Graham, B. S., & Nabel, G. J. (2009). Correlates of Protective Immunity for Ebola vaccines:Implications for Regulatory Approval by the Animal Rule. Microbiology, 7. doi: 10.1038/nrmicro2129