Ebola Virus DRC, October 3, 2019

The outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of Congo continues this week, with 20 new confirmed cases. compared with 29 in the week. previous. This decline in the number of cases should be interpreted with caution, as operational and safety issues in some health zones make case detection and response difficult. More than half (55%) of the cases recorded last week came from the health zones of Mambasa and Mandima, so there is a noticeable change in the areas considered as hot spots of the epidemic, from urban to urban areas. high density, such as Butembo, Katwa and Beni, to more rural areas with lower population density.

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There is a need for more surveillance data and more research into the risks of sexual transmission and, in particular, the presence of viable and
All Ebola survivors and their sexual partners should be counseled on safer sex practices until sperm has twice tested negative. Survivors will be provided with condoms.
Men who survive Ebola should be tested for sperm 3 months after the onset of the disease, then for those who test positive, test each month until they have tested 2 negative tests. looking for the virus in sperm by RT-PCR, with an interval of one week between the 2 tests.

Symptoms of Ebola Virus Disease

The incubation period, ie the time elapsed between infection with the virus and the appearance of the first symptoms, ranges from 2 to 21 days. As long as they do not show symptoms, human subjects are not contagious. The first symptoms are sudden onset fever, muscle pain, headache and sore throat. They are followed by vomiting, diarrhea, rash, symptoms of kidney and liver failure and, in some cases, internal and external bleeding (eg, bleeding gums, blood in the stool). Laboratory tests reveal a decrease in WBC and platelet count, as well as an increase in liver enzymes.

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ebola-infected-person-rescuing

Persistence of the virus in people recovering from Ebola virus disease

Ebola virus is known to persist in the immunoprivileged sites of subjects who have recovered from Ebola virus disease: testes, inner eye, and central nervous system. In women who have been infected during pregnancy, the virus persists in the placenta, amniotic fluid and fetus.
Viral persistence studies indicate that in a small proportion of survivors, some body fluids may test positive for RT-PCR Kit (gene amplification after reverse transcription) for the Ebola virus for more than 9 months.

Diagnostic

Ebola virus disease can be difficult to distinguish clinically from other infectious diseases such as malaria, typhoid fever and meningitis. The following diagnostic methods are used to confirm that Ebola infection is the cause of the symptoms:
enzyme immunoassay (ELISA);
antigen capture detection assays;
serum neutralization test;
reverse transcription followed by a polymerase chain reaction (RT-PCR);
electron microscopy;

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cell-culture

isolation of the virus on cell culture

Careful attention should be given to the selection of diagnostic tests, taking into account the technical characteristics, incidence and prevalence of the disease, as well as the social and medical implications of the results. It is strongly recommended to consider the use of diagnostic tests, which may have had an independent and international evaluation.

The tests currently recommended by WHO are as follows

Automated or semi-automated nucleic acid (NAT) tests for routine diagnostic management.
Rapid antigen detection tests for use in isolated locations or TANs are not readily available. These tests are recommended for screening purposes as part of surveillance activities; Positive tests must nevertheless be confirmed by TANs.

Zika Virus testing strategy
Zika Virus sample

Preferred samples for diagnosis are:

Whole blood taken from EDTA in live patients with symptoms.
Sample of liquid taken from the oral sphere and stored on universal transport medium in deceased patients or if blood collection is not possible.
Samples from patients present an extreme biological risk. Therefore, laboratory tests performed on non-inactivated samples should respect the most stringent containment conditions possible. All biological samples must be placed in a triple packing box (3 successive layers) for national or international transport.

Treatment and vaccines

Oral or intravenous supportive rehydration and the treatment of specific symptoms improve survival rates. No treatment available has yet been proven against Ebola. An experimental Ebola vaccine has been shown to be highly protective against this deadly virus in a major trial in Guinea. This product, called rVSV-ZEBOV, was studied in a trial involving 11,841 people in 2015. Of the 5837 people who received the vaccine, there were no cases of Ebola virus disease. 10 days or more after vaccination.

Control
Tommy Ounas

Tommy Ounas

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