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Wabah saat ebola di afrika barat (penyebab pertama diberitahu Maret 2014), adalah

yang terbesar dan paling kompleks wabah ebola sejak virus ebola ditemukan pada tahun
1976. telah ada lebih banyak kasus dan kematian dalam wabah ini daripada semua orang lain
digabungkan.
Virus ebola menyebabkan penyakit infeksi akut yang sering fatal jika tidak diobati.
Virus ebola milik Filoviridae keluarga virus yang incudes 3 genera: cuevavirus, virus
margburg dan virus ebola. ada 5 spesies yang telah diidentifikasi: Zaire, Bundibugyo, sudan,
reston, hutan tai.
Dengan mempelajari kasus sebelumnya ebola inection cientist telah mengungkapkan
riwayat alami penyakit ini. diperkirakan bahwa kelelawar buah famiy pteropodidae adalah
ebola alami virus tuan rumah. transmisi infeksi ebola adalah melalui kontak langsung
(melalui selaput kulit dan lendir rusak) dengan darah, sekresi, atau cairan tubuh lain dari
orang yang terinfeksi, dan dengan permukaan dan bahan (tempat tidur, pakaian)
terkontaminasi dengan cairan tersebut. dengan mengetahui riwayat alami penyakit kita dapat
menerapkan lima pencegahan tingkat tepat.
Pencegahan dan pengendalian penyakit menular bergantung onn serangkaian
intervensi. meningkatkan kesadaran faktor risiko untuk penyakit menular, upaya
perlindungan dan promotiv bahwa individu dapat mengambil dua cara yang efektif untuk
mengurangi penularan dari manusia infeksi.
Step 1:
Outbreak: an occurrence of disease greater than expected at particular time and place. It may
affect a small and localized group or impact upon thousands of people across an entire
continent
Acute infectious disease: a disease that is caused by the invasion of a host by agents whose
activities harm the host's tissues (that is, they cause disease) and can be transmitted to other
individuals.
Disease: pathological condition that affects part or all of an organism.
Virus: small infectious agent that replicates only inside the living cells of other organisms.
Prevention:
Promotive measures:
Protective:
Step 2
Infectious disease
1. What are the factor that can make infectious disease?
Faktor agen
Virus, bakteri, jamur, parasite, protozoa dll
Faktor host yang merupakan factor risiko untuk timbulnya penyakit:
- Kekebalan. Orang-orang yang tidak mempunyai kekeblan terhdap suatu penyakit
akan mudah terserang penyakit tersebut.
- Sifat-sifat manusia. Higinie perorangan yng jelek akan mudah terserang penyakit
infeksi.
Factor lingkungan
- Lingkungan fisik
Yang termasuk lingkungan fisik antara lain geografik dan keadaan musim.
Misalnya, Negara yang beriklim ropis mempunyai pola penyakit yang berbeda
dengan Negara yang beriklim dinginatau subtropics. Demikian pula antara
nnegara maju dengan Negara berkembang. Dalam satu Negara pun dapat terjadi

perbedaan pola penyakit, misanya daerah pantai dan daerah peegunungan atau
antara kota dan desa.
Lingkungan biologis
Semua makhluk hidup yang berada di sekitar manusia yaitu flora dan fauna.
Lingkungan social economic
Susceptible Host
The last essential component in the chain of infection is the susceptible host.
Susceptibility is affected by: Genetic factors General resistance factors
Specific acquired immunity
1. Genetic factors The role of genetic factors in susceptibility to infectious
diseases is not yet well understood. Genes do seem to play a role in the
progression of HIV disease, and perhaps in individuals susceptibility to
meningococcal meningitis.
2. General resistance factors include many body functions that we take for
granted. Intact skin and mucous membranes help us resist disease. So do the
gastric acid in our stomachs, the cilia in our respiratory tracts, and the cough
reflex.
3. Specific acquired immunity is the greatest influence on host susceptibility.
This immunity is specific to a particular disease agent, and it may be acquired
naturally or artificially.
Natural immunity may be acquired by experiencing an infection, which is called
active natural immunity. Many diseases confer immunity after a single
infection, but many others do not. A single bout of measles or chickenpox, for
example, confers lifelong immunity to that disease. Influenza and salmonella are
examples of infections that do not confer immunity and therefore may recur.
Another mechanism of natural immunity is the transfer of antibodies from the
mother to the newborn child, via the placenta and/or breast milk. This is called
passive natural immunity, and it diminishes after varying lengths of time. It is
very important in giving infants a good head start in life.
Artificial immunity may be acquired through the use of vaccines, toxoids and
immune globulins. Active immunity: Receiving a vaccine or toxoid stimulates
active immunity, since the recipient responds by producing his/her own
antibodies.
Passive immunity: Receiving an antitoxin or immune globulin
confers passive immunity, essentially by borrowing the antibodies of other
people. Passive immunity lasts for only a short time, while active immunity
usually lasts much longer, even for a lifetime.

2. How infection disease can be infected?


Proses terjadinya penyakit disebabkan adanya interaksi antara agen atau factor
penyebab penyakit, manusia sebagai host, dan factor lingkungan. Misalnya proses
terjadinya penyakit TBC karena adanya mikrobakteriu tuberkolusa yang kontak
dengan manusia sebagai host yang rentan, daya tahan tubuh yang rendah dan
perumahan yang tidak hat sebagai factor lingkungan yang menunjang.
Routes of transmission
A mode of transmission is necessary to bridge the gap between the portal of exit from
the reservoir and the portal of entry into the host.
The two basic modes are direct and indirect.

1. Direct transmission occurs more or less immediately. Many diseases are


transmitted by direct contact with the human, animal or environmental reservoir.
Prime examples are sexually transmitted diseases and enteric diseases such as
shigella, giardia and campylobacter. Contact with soil may lead to mycotic (fungal)
diseases.
Droplet spread is also considered direct transmission. Infectious aerosols produced by
coughing or sneezing can transmit infection directly to susceptible people up to three
feet away. Many respiratory diseases are spread this way.
2. Indirect transmission may occur through animate or inanimate mechanisms.
Animate mechanisms involve vectors. Flies may transmit infectious agents such as
shigella in a purely mechanical way, by walking on feces and then on food.
Mosquitoes, ticks or fleas may serve as reservoirs for the growth and multiplication of
agents, for example in malaria or Lyme disease.
Inanimate mechanisms: When disease agents are spread by environmental vehicles
or by air, this is referred to as indirect transmission by inanimate mechanisms.
Anything may be a vehicle, including objects, food, water, milk, or biological
products. o Food is a common vehicle for salmonella infections o Water is the usual
vehicle in cholera outbreaks o Surgical instruments and implanted medical devices
may be the vehicles of staphylococcal infections
Indirect, airborne transmission is important in some respiratory diseases. This occurs
when very tiny particles of respiratory material become suspended in the air (called
aerosols). Such particles may remain suspended and stay infectious for varying
periods of time. They are particularly dangerous because their size (1 to 5 microns)
allows them to be drawn deep into the lungs and retained. Tuberculosis is spread this
way, as is measles in certain settings such as doctors offices. Air may also spread
particles of various sizes from contaminated soil, or from objects such as clothing and
floors.
3. How host defense against infectious diseases?
The human body has several general mechanisms for preventing infectious diseases.
Some of these mechanisms are referred to as nonspecific defenses because they operate
against a wide range of pathogens. Other mechanisms are referred to as specific defenses
because they target particular pathogens and pathogen-infected cells.
Nonspecific mechanisms
Vaccination
A vaccine is either a killed or weakened (attenuated) strain of a particular pathogen, or a
solution containing critical antigens from the pathogen. The body's immune system will
respond to these vaccines as if they contain the actual pathogen, even though the vaccine
is not capable of causing the disease. As a result of the specific immune response,
memory lymphocytes will be present that respond rapidly when the actual pathogen is
encountered. The resulting rapid activation of immune cells prevents disease.
Currently new types of vaccines, the DNA vaccines, are in early stage trials. These
vaccines contain genes that encode proteins from pathogens. When these genes are
inserted into host cells and are expressed in the form of pathogen proteins, an immune
reaction may result.

The ultimate effectiveness of vaccinationeradication of the infectious agenthas been


achieved only for smallpox. The World Health Organization has identified the polio and
measles viruses among the next targets for global eradication.
For a variety of reasons, many diseases are not easily prevented by vaccination. Antibody
response is generally the simplest to induce by vaccination, but some pathogens have
ways to evade the immune response. Intracellular pathogens (such as viruses and some
bacterial and protozoan pathogens) are not directly affected by antibodies because
antibodies cannot pass inside cells. Moreover, during the disease process, some pathogens
acquire an external coat composed of host-derived material while others disguise
themselves by making molecules that resemble host molecules. Thus, the host's immune
system does not identify them as foreign invaders. Still other pathogens mutate quickly,
producing variants of their antigens that are not recognized by the host's immune system,
even though the host survived a previous encounter with that pathogen. Cold and
influenza viruses are examples of rapidly mutating pathogens. Scientists are working to
improve vaccines against these pathogens.

4. How is the mecanism of infection diseases happen in our body ?


The microorganism entered our body
Our body give Immunity respons
Local and systemic clinical symptoms appear
5. Mention some kinds of infectious diseases and give an example !
Sex infectious disease, ex : HIV and AIDS
Infectious disease caused by bacteria, ex : colera, TBC, dysentri, etc
Infectious disease caused by viruses, ex : typus, hepatitis, polio, influenza, etc
Infectious disease caused by fungus and paracite, ex : dermatophytosis, candida,
giardia lamblia, etc
6. Mention what is the steps in checking someone who had infectious disease (doctor) ?
History taking
Physical examination
Diagnostic test (if needed)
Diagnostic
Teraphy and Education
7. How to solve infectious diseases when it happen in our society (DHF) ?
Treatment of Infectious Diseases
While literally meaning "destroyer of life," the term "antibiotic" has become the most
commonly used word to refer to a chemical substance used to treat bacterial infections. The
term "antimicrobial" has a somewhat broader connotation, generally referring to anything that
inhibits the growth of microbes. Technically, the term antimicrobial does not encom-pass the
"antihelminthic" drugs because worms are not microscopically small. Antimicrobials can be
either microbistatic (inhibiting the replication of the microbe) or microbicidal (actually
killing the target microorganism). In the former case, a combination of therapy and immunity
may be required to finally terminate the infection.
Treatment of bacterial diseases
Because bacteria are prokaryotes, it has been relatively easy to find and develop antibacterial
drugs that have minimal side effects. These drugs target structural features and metabolic
characteristics of prokaryotes that are significantly different from those in eukaryotic cells.
Drugs used to treat bacterial diseases can be grouped into categories based on their modes of

action. In general, these drugs inhibit cell wall synthesis, protein synthesis, nucleic acid
synthesis, or other enzyme-catalyzed reactions.
The penicillins and cephalosporins all interfere with the synthesis of the peptidoglycan layer
in prokaryotic cell walls. Because eukaryotes have neither the peptidoglycan components nor
the enzymes that synthesize them, these drugs do not affect the host cells. A second class of
drugs, including chloramphenicol, the tetracyclines, and erythromycin, bind to prokaryotic
ribosomes and inhibit protein synthesis. Prokaryotic ribosomes are structurally different from
eukaryotic ribosomes, so these drugs have minimal effect on eukaryotic cells. Nevertheless,
some of them may be toxic to some human tissues when they are used in high doses or for
prolonged periods of time.
Rifampicin is one of the antibiotics frequently used for treating tuberculosis. This drug
inhibits prokaryotic RNA synthesis. DNA synthesis in prokaryotes may be inhibited by the
fluoroquinolones. In contrast, the sulfonamides stop bacterial infections by inhibiting other
enzymes. Sulfonamides interfere with the synthesis of folic acid, a vitamin necessary for
nucleic acid synthesis. Most bacteria must synthesize their own folic acid because their
membranes are impermeable to external folic acid. Mammalian cells are not affected by
sulfonamides because they are unable to make their own folic acid and have evolved
mechanisms for transporting external folic acid across their membranes.
Treatment of viral diseases
In general, drugs that effectively inhibit viral infections are highly toxic to host cells because
viruses use the host's metabolic enzymes in their reproduction. For this reason, most illnesses
due to viruses are treated symptomatically until the host's immune system controls and
eliminates the pathogen (or the host dies). Antiviral drugs that are used typically target virusspecific enzymes involved in viral nucleic acid synthesis. One of the most familiar of these
drugs is acyclovir, which is used to treat outbreaks of genital herpes. Amantadine is an
antiviral drug sometimes used to prevent or moderate influenza among those at high risk of
severe illness from the disease.
In addition to antiviral drugs that inhibit the replication of the HIV genome (such as AZT),
AIDS patients today are also prescribed proteases that interfere with the packaging of the
HIV genome into virus particles.
Treatment of fungal and parasitic diseases
The development of drugs to treat fungal, protozoan, and helminthic diseases is challenging
because agents that kill or inhibit the growth of these eukaryotic organisms are also highly
toxic to mammalian cells. Because fungi and protozoa are rapidly proliferating cells, drugs
against these organisms tend to target key components of their replicative or biosynthetic
pathways. Common antifungals inhibit sterol syntheses (the azole derivatives) or disrupt the
cell membrane (polyenes like amphotericin B). Most antihelminthic drugs target adult
worms, which are no longer growing and do not replicate. These drugs are often aimed at
inhibiting fundamental processes, such as energy production and muscle function (for
example, the benzimidazoles and avermectins), or at targets involved in egg production or
larval development.
Malaria, a protozoan disease, was successfully treated for many years with chloroquine. In
recent decades, Plasmodium species that are resistant to this drug have appeared and spread

to areas where malaria is a common threat. In those areas, a combination of the drugs
sulfonamide and pyrimethamine is frequently used to treat the disease.

8. Why the infectious diseases still happened in our society ?


Because bad habit of the host
Low nutritions status
Resistens agent

PROMOTIVE & PREVENTIVE


9. What the obstacle and solution to prevent infectious diseases ?
10. How to prevent of a family and community from infectious diseases ?
Keeping the environment clean and make good ventilation, sanitation
Avoid direct contact
11. Apply a healthy lifestyle How the promotive effort to decrease the insident of
infectious disease ?
12. How do we prevent the infection ?
Developed countries have regulations that help protect the general public from
infectious diseases. Public health measures typically involve eliminating the pathogen from
its reservoir or from its route of transmission. Those measures include ensuring a safe water
supply, effectively managing sewage treatment and disposal, and initiating food safety,
animal control, and vaccination programs.
Safewater
Many pathogens that cause gastrointestinal diseases (for example, those that cause cholera
and typhoid fever) are transmitted via water. Travelers to developing countries are frequently
advised to be immunized against these diseases. This is generally unnecessary in the United
States and other developed countries because the water used for washing, drinking, and
preparing food is purified before it goes into homes. Purification methods include settling,
filtration, and chlorination. The water for homes that use well water or springs is usually safe
if guidelines about distance from sewage disposal facilities are followed; however, this water
should be checked periodically. When breakdowns in a purification system occur, or when a
system is overwhelmed (for example, due to unusual flooding), drinking water may not be
safe and should be boiled or treated with chlorine before it is ingested.
Because gastrointestinal pathogens typically leave the body in the feces, public water must be
guarded against contamination from sewage. Municipal water is usually tested for the
presence of coliform organisms (nonpathogenic microorganisms that are part of the normal
flora of the gastrointestinal tract) as indicators of sewage contamination. This procedure is
necessary because when the water contains pathogens and is potentially dangerous, the
pathogenic organisms are usually present in such small numbers that they are hard to detect.
Sewage treatment and disposal
Sewage includes wash water, water from toilets, and storm run-off. These fluids may carry
the pathogens for many waterborne diseases, including giardiasis and hepatitis A; therefore,
to ensure public safety the U.S. government (and the governments of other developed
countries) requires that sewage be treated to eliminate pathogens. The minimal acceptable

level of treatment involves collection and sedimentation of sewage waters, separating solid
matter (sludge) from the liquid (effluent) portion of sewage. The effluent is chlorinated to kill
pathogens before it is released to rivers or lakes. The sludge is burned or dumped.
More advanced methods of treatment use a secondary treatment following this primary
treatment. The effluent is transferred to tanks containing a population of microorganisms that
decompose more than 90 percent of the organic wastes and eliminate pathogens by
competition (this is another example of the important role of microorganisms in preventing
disease). The resulting effluent is chlorinated before it is released to the environment. Some
sewage treatment plants include a tertiary treatment that involves additional chemicals that
also eliminate pathogens.
Food safety programs
The United States has many standards, inspection plans, and regulations about food
preparation, handling, and distribution. Meat-packing facilities are inspected regularly to
detect and eliminate diseased animals, ensure that standards for processes such as meat
cutting and refrigeration are observed, and detect residues from pesticides and antibiotics as
well as contamination by bacteria and other parasites. Restaurants and supermarkets are
similarly inspected. Milk is pasteurized and dated for sale and is analyzed periodically for
contamination. Industry standards for canning and preserving foods are maintained through
periodic quality control checks and, if contamination is found in representatives of any
batches, public health officials recall the entire batch and alert the public through the media.
Animal-control programs
Animals are carriers of many diseases that also affect humans. Inspecting domestic herd
animals for tuberculosis (due to the bacterium Mycobacterium bovis) and brucellosis (a
disease that causes spontaneous abortion in domestic herd animals and abscesses of the liver,
spleen, bone marrow, and lymph nodes in humans) has helped eliminate the threat of passing
the pathogens for those diseases to humans in contaminated milk and meat. Before their pets
can be licensed, dog owners must show proof of rabies vaccination. Because most cases of
rabies among people in the United States are due to bites from wild and stray animals, health
officials are mandated to impound and destroy these animals. Many diseases, including
bubonic plague, are spread by rodents, and rat control, especially in urban areas, is a major
component of public health efforts. Insects also transmit many diseases (a notable example is
malaria). The spread of insect-borne diseases can be controlled by eliminating breeding areas
for insects (for example, draining areas where stagnant water collects) and using pesticides.
Many imported animals must be tested for specific diseases to prevent the introduction of
those diseases into the country.

Vaccination programs
Most states now require that parents or guardians show
proof of vaccination before their children can be
enrolled in day-care facilities or public schools,
although some states allow certain exemptions,
including exemptions based on religious beliefs. The
value of immunization for an individual's health is
obvious; however, it is also important for public health.
If a certain proportion of a population (called the
threshold proportion) is immune to a disease, the
pathogen that causes that disease will be unable to
reproduce itself at a high enough level to maintain itself
in the population. This is because once the infected host Figure 6 - Vaccination programs
recovers or dies, there will not be enough new, are important components of
susceptible hosts for the pathogen to infect. Eventually, public health systems.
the pathogen cannot spread any further and could be
eliminated from the population. Even if elimination of the pathogen does not occur, there will
be relatively few cases of the related disease and epidemics of the disease in the population
will be avoided. This phenomenon is called herd immunity.
The threshold proportion varies depending on the disease and other conditions in the relevant
population. Vaccination programs led by public health officials aim to achieve the
immunization of at least the threshold number of individuals for the population.

13. What is the characteristic ebola


14. When does the infection occur in our body and what is the symptoms of infectious
diseases ?
NATURAL HISTORY OF DISEASE
15. What is natural history of disease ?
the uninterrupted progression of a disease in an individual from the moment of
exposure to causal agents until recovery or death.
16. What is the function natural history of disease ?
17. Why the doctor must explain about natural history of disease ?

The stages of prevention


Chapter 1 illustrated how the development of any disease in a patient progresses through a
natural history that can, for convenience, be broken into a series of stages. Preventive
measures can be applied at any stage along the natural history of a disease, with the goal of
preventing further progression of the condition (see Prevention in Glossary). For the purposes
of introduction it is convenient to think of preventive actions in terms four main stages, but in
reality the stages blur one into the next.
Primordial prevention consists of actions to minimize future hazards to health and hence
inhibit the establishment factors (environmental, economic, social, behavioural, cultural)
known to increase the risk of disease.2 It addresses broad health determinants rather than
preventing personal exposure to risk factors, which is the goal of primary prevention. Thus,
outlawing alcohol in certain countries would represent primordial prevention, whereas a
campaign against drinking and would be an example of primary prevention.

Examples of primordial include improving sanitation (such that exposure to infectious agents
does not occur), establishing healthy communities, promoting a healthy lifestyle in childhood
(for example, through prenatal nutrition programs and supporting early childhood
development programmes), or developing green energy approaches. Starfield et al. give more
examples.2 So, in preventing Catherine Richardss diabetes, subsidized fitness programmes at
the sports centre could have made make such activities more affordable for women like her,
and could help to make exercise a norm for women in her community. Similarly, increasing
sports programmes in schools may help reduce obesity in the subsequent generations.3 As
these are all population-level programmes, primordial prevention is conceptually linked to
population health and health promotion, but clinicians can play a role bringing problems to
notice and advocating for action on determinants.
Healthy communities.
During the early 1980s the European regional office of the World Health Organization
(WHO) proposed actions to improve the quality of life in cities by making the urban
environment conducive to healthy living: providing recreational resources, improved
transportation, cleaner environments, more pleasant housing and so on. Toronto was an early
participant in the healthy cities movement.4
Primary prevention seeks to prevent the onset of specific diseases via risk reduction: by
altering behaviours or exposures that can lead to disease, or by enhancing resistance to the
effects of exposure to a disease agent. Examples include smoking cessation and vaccination.
Primary prevention reduces the incidence of disease by addressing disease risk factors or by
enhancing resistance. Some approaches involve active participation, as with regular tooth
brushing and flossing to prevent dental caries. Other approaches are passive: adding fluoride
to the municipal drinking water to harden tooth enamel and prevent caries. Primary
prevention generally targets specific causes and risk factors for specific diseases, but may
also aim to promote healthy behaviours, improve host resistance, and foster safe
environments that reduce the risk of disease, for instance, thorough cleaning of operating
rooms to prevent post-operative infection. Preventive efforts can be fitted into the agent-hostenvironment model of causation introduced in Chapter 2.
Secondary prevention includes procedures that detect and treat pre-clinical pathological
changes and thereby control disease progression. Screening procedures (such as
mammography to detect early stage breast cancer) are often the first step, leading to early
interventions that are more cost effective than intervening once symptoms appear. Routine
blood sugar testing for people over 40 would be an example relevant to detecting Catherines
diabetes early. Screening is usually undertaken by health professionals, either at the level of
individual doctor-patient encounters (e.g., routine blood pressure checks) or via public health
screening programs (e.g., mammography screening). The criteria for implementing a
screening programme are described in Part 3.
Once a disease has developed and has been treated in its acute clinical phase, tertiary
prevention seeks to soften the impact caused by the disease on the patients function,
longevity, and quality of life. Examples include cardiac rehabilitation following a myocardial
infarction, seeking to alter behaviours to reduce the likelihood of a reinfaction. Tertiary
prevention can include modifying risk factors, such as assisting a cardiac patient to lose
weight, or making environmental modifications to reduce an asthmatic patients exposure to
allergens. In the example of Catherine Richards, it might include ensuring regular check-ups
to monitor her condition, including eye exams to check for possible adverse outcomes of her

diabetes. Where the condition is not reversible, tertiary prevention focuses on rehabilitation,
assisting the patient to accommodate to his disability. For reversible conditions, such as many
types of heart disease, tertiary prevention will reduce the population prevalence, whereas for
incurable conditions it may increase prevalence if it prolongs survival. The key goal for
tertiary prevention is to enhance quality of life.
Table 4.1illustrates the primary, secondary and tertiary levels of prevention.
Table 4.1: Examples of primary, secondary, and tertiary prevention interventions
targeting individuals and populations
Disease

Intervention Primary
level

Colorectal Individual
cancer

Secondary

Tertiary

Counselling on healthy Hemoccult stool


lifestyles:
dietary testing to detect
counselling for people colorectal
at risk of colorectal cancer early
cancer, etc.

Follow-up exams to
identify recurrence or
metastatic
disease:
physical examination,
liver enzyme tests,
chest x-rays, etc.

Population

Publicity
campaigns
alerting the public to the
benefits of lifestyle
changes in preventing
colorectal
cancers;
promotion of high fibre
diets; subsidies to help
people access exercise
programmes;
antismoking campaigns

Organized
colonoscopy
screening
programs

Implementation
of
health
services
organizational models
that improve access to
high-quality care

Infectious Individual
diseases:
hepatitis C

Counselling on safe
drug use to prevent
hepatitis C virus (HCV)
transmission;
counselling on safer sex

Screening for HCV therapy to cure


HCV infection infection and prevent
of patients with transmission
a history of
injection drug
use

Population

HCV
prevention
includes
safer
sex
practices, programmes
to discourage needle
sharing
among
intravenous drug users,
etc.

Establish
a
universal testing
system for HCV
in high risk
groups

Individual

Nutrition and exercise Screening


counselling
diabetes

Population

Built
environment Community
Implementation
favourable for active level
weight multidisciplinary
transport
(walking, loss
and clinics

Metabolic
syndrome

(Similar to primary
prevention): ensuring
close control of high
risk sites such as tattoo
parlours that have been
associated
with
outbreaks

for Referral to cardiac


rehabilitation clinics
of

bicycling rather
using a car)

than exercise
programs
control
metabolic
syndrome

to

Infection Mechanism of Genus Ebolavirus


By Keith Miller, Kenyon College, 2010
Ebola virus disease (formerly called Ebola Hemorrhagic disease) is a severe, often fatal,
disease in humans and non-human primates caused by the Ebola virus (Fig 1). In 2014, a
major outbreak of Ebola Virus spread amongst several African countries, including Sierra
Leone, Guinea, and Liberia. The virus first appeared in the Democratic Republic of the
Congo (formerly Zaire) in the summer of 1976. Most outbreaks have been small, but the
virus captured the attention of the world due to death rates that can be as high as 90% as well
as the visceral manner in which it kills [7,24]. Few viruses have the ability to turn internal
organs into a soup that promptly flows out of the body, so those that do tend to capture the
public eye.

Figure 1. Medical personnel tending a patient infected with Ebola virus. [1].
The infection by Ebola virus is not transmitted until its late stage, when bodily fluids carry
the virus; infected individuals who are isolated early to not transmit the virus. For the latest
medical details, please see the Centers for Disease Control.
Despite the low incidence of infection, the lethality and potential for short-range aerosol
transmission of Ebola virus in patients with advanced illness makes the virus a severe
biological threat. This is compounded by the possibility of the virus being obtained from the
wild for use as a biological weapon, something Japanese terrorist cult Aum Shinrikyo once
unsuccessfully attempted [5]. As of the present, there are no licensed vaccines or specific
antiviral treatments available for Ebola virus infections, with significant progress only made
in the development of vaccines for nonhuman primates [34]. Therefore, the elucidation of the
viral replication cycle as well as complete understanding of viral proteins is necessary for the
production of human treatments.

Ebola Virus Disease


This mysterious disease was first described in two separate 1976 outbreaks (Fig 2): first in
southern Sudan and subsequently in northern Zaire, now Democratic Republic of the Congo.
A causative agent was isolated from patients in both epidemics and named Ebola virus after a
small river in northwestern Zaire. Only years later did researchers recognize that the plagues
were caused by two distinct species of Ebola virus, Sudan Ebola virus and Zaire Ebola virus.
The third African species, Cote d'Ivoire Ebola virus was isolated in 1994 from an infected

ethnologist who had done a necropsy on a chimpanzee from the Tai Forest. Only in 2007 was
a fourth African species, Bundibugyo Ebola virus, isolated [13].

Figure 2. Locations of African Ebola virus infections and outbreaks (Feldmann & Geisbert
2010).
An additional viral species, Reston Ebola virus, has origins in the Philippines. It was first
discovered in a quarantine facility for Cynomolgus monkeys (Macaca fascicularis) in Reston,
VA, USA, and made popular by Richard Preston's best-selling novel The Hot Zone. Luckily
for the monkey caretakers, this is the only strain that is non-pathogenic in humans. Recently,
Reston Ebola virus has been found infecting pigs in the Philippines. This raises important
concerns for public health and food safety in this country, causing some to worry that this
could turn into a serious problem for parts of Asia [13].
The Ebola virus enters the host primarily through mucosal surfaces or skin abrasions, with
most human infections occurring after direct contact with patients or cadavers. In addition,
there have been several cases in which hunters are infected after eating contaminated meat
found in the forest. Also, most Ebola outbreaks are centered in hospitals in Africa where
practices of basic hygiene and sanitation are considered luxuries (Fig 3). However, in modern
hospitals with disposable needles and knowledge of basic hygiene and barrier nursing
techniques, the virus rarely spreads on a large scale. Airborne transmission between monkeys
was demonstrated during the outbreak of Reston Ebola virus in Virginia, but there is limited
evidence of airborne transmission in any human epidemics [13].

Figure 3. Modes of infection of the Ebola virus [2].


One of the reasons that Ebola is so dangerous is that its symptoms are varied and appear
quickly, yet resemble those of other viruses so much that the hemorrhagic fever is not rapidly
diagnosed. Generally, the abrupt onset of symptoms follows an incubation period of 2-21
days and is characterized by high fever, chills and myalgia. Subsequent signs of infection
indicate multisystem involvement and include gastrointestinal (nausea, vomiting, diarrhea),
respiratory (chest pain, cough) and neurological (headache) manifestations. The unfortunate
thing about these symptoms is that they are easily mistaken for malaria, typhoid fever,
dysentery, influenza or various bacterial infections, all of which are far more common in
regions where Ebola is prevalent, but also less fatal [7].

Figure 4. An individual suffering from internal hemorrhage and hemorrhagic shock caused
by Ebola virus [3].
After these initial symptoms, the fever often progresses to cause more serious ones: diarrhea,
dark or bloody feces, vomiting blood, red eyes due to distention and hemorrhage of sclerotic
arterioles, petechia, maculopapular rash and purpura. There is often gastrointestinal bleeding
from the mouth and rectum, sometimes leading to the sloughing of the gut and venting from
the anus. Internal and external hemorrhage from orifices, such as the nose and mouth, may

also occur. As the virus progresses, bleeding in the brain can lead to severe depression,
seizures and delirium [7].
The span of time from onset of symptoms to death is usually between 6 and 16 days. By the
second week of the infection, the patient will either experience a full recovery or undergo
systemic multiorgan failure. Mortality rates are generally high, ranging from 50-90%
depending on the specific strain. The cause of death is normally due to hypovolemic shock or
organ failure (Fig 4). While hemorrhages can be severe and have been the calling card of this
virus, they are actually present in fewer than half of patients [53]. Here, Chief Epidemiologist
Philippe Calain from the CDC Special Pathogens Branch sums up the appearance of his
patients during the 1995 Ebola outbreak in Kikwit:
"At the end of the disease the patient does not look, from the outside, as horrible as you can
read in some books. They are not melting. They are not full of blood. They're in shock,
muscular shock. They are not unconscious, but you would say 'obtunded', dull, quiet, very
tired. Very few were hemorrhaging. Hemorrhage is not the main symptom. Less than half of
the patients had some kind of hemorrhage. But the ones that had bled, died" [
in a host follows a potentially predictable life cycle from onset to final outcome, which is
known as its natural history. Understanding the natural history of disease is important to
clinicians in establishing appropriate treatment and accurate prognosis, and it is vital to
public health professionals in developing effective disease prevention and control
strategies. Although the life cycle or natural history of a particular disease will vary
somewhat from individual to individual, and different diseases will each have their own
distinct natural histories, it is possible to identify four common stages that most disease
manifests:
Stage
of
susceptility
Stage
of
presymptomatic
disease
Stage
of
clinical
disease
Stage
of
diminished
capacity
The stage of susceptibility recedes the onset of disease. The disease has not yet
developed, but the host is susceptible due to the presence of risk factors. Individuals with
high serum cholesterol, hypertension, a sedentary lifestyle, and diabetes, for example,
have an increased risk of developing coronary heart disease. Likewise .lack of sleep,
excessive stress, and poor eating habits may predispose one to the common cold.
Epidemiologists are continually seeking to identify and confirm risk factors for the major
health problems that affect society. Ongoing research to determine if alcohol consumption
is an important risk factor for breast cancer is one example.
In the stage of presymptomatic disease the disease process has begun, but no overt
signs or symptoms are evident to the host. For noncommunicable diseases, this stage
includes the incubation period, which is the time between the invasion of an infectious
agent and the development of the first signs or symptoms of the disease. The total number
of infections that resulted from her presence could number in the thousands. A carrier of a
communicable disease is an individual who has no symptoms of the disease but
nevertheless harbors the causative agent.