Ebola Epidemic 2014 The disease and the impact George Smulian M.D. Infectious Disease Division Director, UC COM Chief, ID Section Cincinnati VAMC
Ebola Virus – the agent • Filovirus • Negative strand RNA virus CDC 2014
Country Town Cases Deaths Species Year Dem. Rep. of Zaire Yambuku 318 280 1976 Congo ebolavirus Sudan South Sudan Nzara 284 151 1976 ebolavirus Sudan South Sudan Nzara 34 22 1979 ebolavirus Zaire Gabon Mekouka 52 31 1994 ebolavirus Taï Forest Ivory Coast Tai Forest 1 0 1994 ebolavirus Dem. Rep. of Zaire Kikwit 315 250 1995 Congo ebolavirus Zaire Gabon Mayibout 37 21 1996 ebolavirus Zaire Gabon Booue 60 45 1996 ebolavirus Zaire South Africa Johannesburg 2 1 1996 ebolavirus Zaire Uganda Gulu 425 224 2000 ebolavirus Zaire Gabon Libreville 65 53 2001 ebolavirus Republic of Zaire Mbomo 143 128 2002 Congo ebolavirus Republic of Zaire Mbomo 35 29 2003 Congo ebolavirus Zaire South Sudan Yambio 17 7 2004 ebolavirus Dem. Rep. of Zaire Luebo 264 187 2007 Congo ebolavirus Bundibugyo Uganda Bundibugyo 149 37 2007 ebolavirus Dem. Rep. of Zaire Luebo 32 15 2008 Congo ebolavirus Sudan Uganda Luwero District 1 1 2011 ebolavirus Dem. Rep. of Isiro Health Bundibugyo 36* 13* 2012 Congo Zone ebolavirus Sudan Uganda Luwero District 6* 3* 2012 ebolavirus
How contagious is Ebola? R 0 = Reproduction ration Adam Cole/NPR 2014
CDC 2014
Wikipedia.org
Wikipedia.org
Pathogenesis • Broad cellular tropism • Macrophages, dendritic cell and monocytes preferred sites of replication • VP35 acts as a type 1 interferon inhibitor Lancet 2012
Diagnosis Timeline of Infection Diagnostic tests available •Antigen-capture ELISA testing Within a few days after •IgM ELISA symptoms begin •PCR •Virus isolation Later in disease course or •IgM and IgG antibodies after recovery •Immunohistochemistry testing Retrospectively in deceased •PCR patients •Virus isolation
Impact • Local – Deaths secondary to EVD – Economic impacts • Reduced social interaction – Increased isolation – Impact on education • Reduced commerce – Markets deserted – Entertainment industry devastated • Reduced agricultural production – Crops rotting in fields due to lack of farm workers
Impact • Local – Health impacts • Disease related • Diversion of routine health spending/services – Per capita spending in Liberia, Guinea and Sierra Leone - $39-96 per year • Nutritional impact – Increased poverty and malnutrition • Infrastructure investment – New investment may improve long term health outcomes
Global Impact • World Bank / IMF prediction of $32.9 billion impact on West African countries – Cocoa prices increased 10% in past 2 months • Reduced integration to world economy – Reduced travel, investment • Redirected health spending – Finite health care spending • Reduced spending on other efforts
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