Ebola Hemorrhagic Fever, Kikwit, Democratic Republic of the Congo, 1995: Risk Factors for Patients without a Reported Exposure

Roels, Thierry H.; Bloom, Art; Buffington, Joanna; Muhungu, G. L.; Kenzie, William R. Mac; Khan, Ali S.; Ndambi, Roger; Noah, Donald L.; Rolka, Henry; Peters, C. J.; Ksiazek, Thomas G.

doi:10.1086/514286

Cited by 126 publications

(96 citation statements)

References 12 publications

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“…In addition, recent studies have demonstrated that pigs can be infected mucosally with EBOV and then transmit the virus to other, naive pigs (15) and to naive NHPs (16). The establishment of interspecies transmission without direct contact, in addition to past epidemiological observations (17), supports the notion that airborne EBOV transmission could potentially contribute, albeit at a low level, to the spread of disease during an outbreak.…”

Section: Importancementioning

confidence: 58%

Ebola Virus Transmission in Guinea Pigs

Wong

Qiu

Richardson

et al. 2015

J Virol

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Ebola virus (EBOV) transmission is currently poorly characterized and is thought to occur primarily by direct contact with infectious material; however transmission from swine to nonhuman primates via the respiratory tract has been documented. To establish an EBOV transmission model for performing studies with statistical significance, groups of six guinea pigs (gps) were challenged intranasally (i.n.) or intraperitoneally (i.p.) with 10,000 times the 50% lethal dose (LD 50 ) of gp-adapted EBOV, and naive gps were then introduced as cage mates for contact exposure at 1 day postinfection (p.i.). The animals were monitored for survival and clinical signs of disease and quantitated for virus shedding postexposure. Changes in the duration of contact of naive gps with infected animals were evaluated for their impact on transmission efficiency. Transmission was more efficient from i.n.-than from i.p.-challenged gps, with 17% versus 83% of naive gps surviving exposure, respectively. Virus shedding was detected beginning at 3 days p.i. from both i.n.-and i.p.-challenged animals. Contact duration positively correlated with transmission efficiency, and the abrogation of direct contact between infected and naive animals through the erection of a steel mesh was effective at stopping virus spread, provided that infectious animal bedding was absent from the cages. Histopathological and immunohistochemical findings show that i.n.-infected gps display enhanced lung pathology and EBOV antigen in the trachea, which supports increased virus transmission from these animals. The results suggest that i.n.-challenged gps are more infectious to naive animals than their systemically infected counterparts and that transmission occurs through direct contact with infectious materials, including those transported through air movement over short distances. IMPORTANCEEbola is generally thought to be spread between humans though infectious bodily fluids. However, a study has shown that Ebola can be spread from pigs to monkeys without direct contact. Further studies have been hampered, because an economical animal model for Ebola transmission is not available. To address this, we established a transmission model in guinea pigs and determined the mechanisms behind virus spread. The survival data, in addition to microscopic examination of lung and trachea sections, show that mucosal infection of guinea pigs is an efficient model for Ebola transmission. Virus spread is increased with longer contact times with an infected animal and is possible without direct contact between an infected and a naive host but can be stopped if infectious materials are absent. These results warrant consideration for the development of future strategies against Ebola transmission and for a better understanding of the parameters involved in virus spread.

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Section: Importancementioning

confidence: 58%

Ebola Virus Transmission in Guinea Pigs

Wong

Qiu

Richardson

et al. 2015

J Virol

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“…These arthropathies result from either viral replication or the deposition of immune complexes in joint tissue. In other studies, antibody levels were greater among convalescents with arthralgias, indicating (indirectly) the role of persistent low-level antigenic stimulation (Dowell and others 1999;Rodriguez and others 1999;Roels and others 1999;Rowe and others 1999).…”

Section: Immunological Manifestations Among Survivors Of Ehfmentioning

confidence: 77%

Ebola Virus: Immune Mechanisms of Protection and Vaccine Development

Nyamathi¹,

Fahey²,

Sands³

et al. 2003

Biological Research For Nursing

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Vaccination is one of our most powerful antiviral strategies. Despite the emergence of deadly viruses such as Ebola virus, vaccination efforts have focused mainly on childhood communicable diseases. Although Ebola virus was once believed to be limited to isolated outbreaks in distant lands, forces of globalization potentiate outbreaks anywhere in the world through incidental transmission. Moreover, since this virus has already been transformed into weapongrade material, the potential exists for it to be used as a biological weapon with catastrophic consequences for any population vulnerable to attack. Ebola hemorrhagic fever (EHF) is a syndrome that can rapidly lead to death within days of symptom onset. The disease directly affects the immune system and vascular bed, with correspondingly high mortality rates. Patients with severe disease produce dangerously high levels of inflammatory cytokines, which destroy normal tissue and microcirculation, leading to profound capillary leakage, renal failure, and disseminated intravascular coagulation. Vaccine development has been fraught with obstacles, primarily of a biosafety nature. Case reports of acutely ill patients with EHF showing improvement with the transfusion of convalescent plasma are at odds with animal studies demonstrating further viral replication with the same treatment. Using mRNA extracted from bone marrow of Ebola survivors, human monoclonal antibodies against Ebola virus surface protein have been experimentally produced and now raise the hope for the development of a safe vaccine.

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“…9 We considered the risks of transmission via food crops and via disposal of waste directly onto the ground to be low -primarily because of the lack of evidence of such transmission 40 but also because solar radiation and other environmental stressors, such as antiviral microbial activity in soils, may rapidly inactivate the virus. However, it is worth noting that there is evidence highlighting contact with raw sewage as a transmission route for many other pathogens.…”

Section: Cleaning and Disinfecting Of Nonhuman Wastementioning

confidence: 99%

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach

Edmunds

Elrahman

Bell

et al. 2016

Bull. World Health Organ.

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Objective To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. Methods A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. Findings The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. Conclusion The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.

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Ebola Hemorrhagic Fever, Kikwit, Democratic Republic of the Congo, 1995: Risk Factors for Patients without a Reported Exposure

Cited by 126 publications

References 12 publications

Ebola Virus Transmission in Guinea Pigs

Ebola Virus Transmission in Guinea Pigs

Ebola Virus: Immune Mechanisms of Protection and Vaccine Development

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach

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