Ebolavirus

Ebola-virus-structure

 

I don’t sell things. I don’t get kickbacks or bonus checks or free products from “partners” who profit from my recommendations. I don’t have a book, an e-book, or a class, to sell you. I write. I recommend products I find useful and pass along connections to information that I have found to be valuable for me. Maybe you’ll find the products useful as well… or maybe they just won’t work for your needs. Maybe the information will be valuable to you, or maybe it won’t fit with the situation in which you find yourself. But that’s the important lesson about being prepared: preparedness is personal. What works for me may not work for you. All the money in the world won’t help you if the stuff you have isn’t the stuff you need… and the stuff you need won’t help you if you don’t have the know-how to put it to good use.

That being said, a LOT of people are going to start harping about Ebolavirus. You’re going to hear about “near magic formulas” that will protect your family. You’re going to hear about “the cures the government doesn’t want you to know about.” Most of what you’re going to hear is crap. It’s crap designed to separate you from your hard-earned dollars.

I don’t know about you, but I’m living on blue collar wages. And I need every bit of the money I take home. I don’t have the disposable income to blow on “miracle cures” and “secrets” that amount to nothing. I need solid, practical advice. I don’t have time or money for crap. I bet you don’t either.

I don’t believe in hoarding knowledge for profit. I believe in sharing it. I believe that knowledge is power. The more you know, the safer you can be in most circumstances.

I’m about to pass along the best info I’ve found on Ebolavirus. It’s a Pathogen Safety Data Sheet for Ebolavirus issue by the Public Health Agency of Canada. A Pathogen Safety Data Sheet is sort of like a Material Safety Data Sheet: it helps you know what you’re dealing with and how best to keep yourself as safe as possible. Like an MSDS, a PSDS takes something complex and breaks it down into more manageable pieces.

After the link, I’m going to present some pertinent excerpts from the text from the PSDS with notes & annotations to help clear up some of the medical terminology and put things in layman’s terms. Here’s something else, a disclaimer… because y’know… the lawyers and ambulance chasers are always out there… I’m not a medical professional. I’m a regular woman trying to figure things out. I use a dictionary and Google and WebMD and AltaVista and DuckDuckGo to find facts and define words that I don’t understand. I can’t give you medical advice. And if you go out and do something stupid or deliberately put yourself in harm’s way and cut corners and get infected with something, that’s on you. If you have questions or you’re sick, you should consult medical professionals.

You’ll also see how quite a LOT of this just isn’t going to apply to you. Currently your odds of coming into contact with anyone who’s infected are quite low… unless you make a habit of travelling to hot zones, or you have a job that puts you in proximity to infected persons.

Here’s the link to the best info I’ve found on Ebolavirus:

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

Here’s the pertinent info from the PSDS [my notes/comments are in BOLD italic type]:

PATHOGEN SAFETY DATA SHEET – INFECTIOUS SUBSTANCES

SECTION I – INFECTIOUS AGENT

NAME: Ebolavirus

SYNONYM OR CROSS REFERENCE: African haemorrhagic fever, Ebola haemorrhagic fever (EHF, Ebola HF), filovirus, EBO virus (EBOV), Zaire ebolavirus (ZEBOV), Sudan ebolavirus (SEBOV, SUDV), Ivory Coast ebolavirus (ICEBOV), Tai Forest ebolavirus (TAFV), Ebola-Reston (REBOV, EBO-R, Reston Virus, RESTV), Bundibugyo ebolavirus (BEBOV, BDBV), and Ebola virus disease (EVD) Footnote 1 Footnote 2 Footnote 3 Footnote 4.

Essentially, this section lets you know that there are several strains of Ebolavirus.

 

SECTION II – HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Ebola virions enter host cells through endocytosis and replication occurs in the cytoplasm. Upon infection, the virus affects the host blood coagulative and immune defence system and leads to severe immunosuppression Footnote 10 Footnote 12. Early signs of infection are non-specific and flu-like, [this is why people often wait too long to seek treatment… it presents like the flu] and may include sudden onset of fever, asthenia [weakness, lack of energy], diarrhea, headache, myalgia [muscle aches], arthralgia [weakness, lack of joint pain], vomiting, and abdominal pains Footnote 13. Less common early symptoms include conjunctival injection [“red eye,” severely bloodshot eyes], sore throat, rashes, and bleeding. Shock, cerebral oedema [fluid on the brain], coagulation disorders, and secondary bacterial infection may co-occur later in infection Footnote 8. Haemorrhagic symptoms may begin 4 – 5 days after onset, including hemorrhagic conjunctivitis [extremely red and swollen eyes w/ bleeding], pharyngitis, bleeding gums, oral/lip ulceration, hematemesis [vomiting blood], melena [black, tarry feces – associated with blood in the GI tract], hematuria [blood in the urine], epistaxis [nosebleed], and vaginal bleeding Footnote 14. Hepatocellular damage [liver damage], marrow suppression (such as thrombocytopenia [low blood platelet count], and leucopenia [decreased white blood cell count]), serum transaminase elevation [abnormal liver enzymes – but this makes sense since liver damage is part of the deal], and proteinuria [excess protein in the urine],may also occur. Persons that are terminally ill typically present with obtundation [decreased mental alertness], anuria [a condition in which the kidneys fail to produce urine], shock, tachypnea [rapid breathing], normothermia to hypothermia [normal to low body termperature – which is weird since fever hits you at the onset], arthralgia, and ocular diseases Footnote 15. Haemorrhagic diathesis [susceptibility to bleeding], is often accompanied by hepatic damage [liver damage], and renal failure [kidney failure], central nervous system involvement, and terminal shock with multi-organ failure Footnote 1 Footnote 2. Contact with the virus may also result in symptoms such as severe acute viral illness, malaise [you feel like s***], and maculopapular rash. Pregnant women will usually abort their foetuses and experience copious bleeding Footnote 2 Footnote 16. Fatality rates range between 50 – 100%, with most dying of hypovolemic shock [shock caused by the heart not having enough fluid to pump effectively], and multisystem organ failure Footnote 17.

They treat Ebolavirus by trying to keep your organs going and hoping that your immune system will be able to beat it back.   When you understand what Ebolavirus does in your body, suddenly the treatment protocols make a little more sense.

INFECTIOUS DOSE: Viral hemorrhagic fevers have an infectious dose of 1 – 10 organisms by aerosol in non-human primates Footnote 41.

This is a really small dose of viral organisms. So, caution is called for. Aerosol is different from airbone. Aerosol means that the virus has to be transported IN another substance. If it were truly airborne it wouldn’t need another substance, it would just float invisibly, microscopically in the air. IT DOESN’T DO THAT AND HASN’T MUTATED TO BE ABLE TO DO THAT. AEROSOL IS DIFFERENT FROM AIRBORNE.

MODE OF TRANSMISSION: Person-to-person transmission occurs via close personal contact with an infected individual or their body fluids during the late stages of infection or after death Footnote 1 Footnote 2 Footnote 22 Footnote 42. Nosocomial infections can occur through contact with infected body fluids for example due to the reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids Footnote 1 Footnote 2. Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals Footnote 2 Footnote 10 Footnote 43.

Person-to-person transmission occurs through contact with infected bodily fluids or tissues.

INCUBATION PERIOD: Two to 21 days Footnote 1 Footnote 15 Footnote 17.

COMMUNICABILITY: Communicable as long as blood, body fluids or organs, contain the virus. Ebolavirus has been isolated from semen 61 to 82 days after the onset of illness, and transmission through semen has occurred 7 weeks after clinical recovery Footnote 1 Footnote 2 Footnote 59 Footnote 60.

82 days. Use a condom.

 

SECTION III – DISSEMINATION

RESERVOIR: The natural reservoir of Ebola is unknown Footnote 1 Footnote 2. Antibodies to the virus have been found in the serum of domestic guinea pigs and wild rodents, with no relation to human transmission Footnote 34 Footnote 47. Serum antibodies and viral RNA have been identified in some bat species, suggesting bats may be a natural reservoir Footnote 37 Footnote 38 Footnote 39 Footnote 40.

No one knows where it lives in nature. In the States, it’ll be people.

ZOONOSIS: Zoonosis between humans and animal is suspected Footnote 2 Footnote 22 Footnote 37.

VECTORS: Unknown.

 

SECTION IV – STABILITY AND VIABILITY

All information available on stability and viability comes from peer-reviewed literature sources depicting experimental findings and is intended to support local risk assessments in a laboratory setting.

DRUG SUSCEPTIBILITY: Unknown. Although clinical trials have been completed, no vaccine has been approved for treatment of ebolavirus. Similarly, no post-exposure measures have been reported as effective in treating ebolavirus infection in humans although several studies have been completed in animals to determine the efficacy of various treatments.

DRUG RESISTANCE: There are no known antiviral treatments available for human infections.

As the situation continues to unfold, we’re hearing about more & more experimental drugs, vaccines & therapies. When the Canadians generated the PSDS there were no known antiviral treatments available… that is to say that there wasn’t an antiviral drug that would successfully combat Ebolavirus. . It doesn’t mean that there aren’t treatment measures to be taken for an infected person.

Currently I think it’s safe to assume that someone who’s suspected of infection will have everything thrown at them in order to stop the spread of the disease. The question, as we saw with the drug ZMapp is whether the demand will outstrip the supply.

 

SUSCEPTIBILITY TO DISINFECTANTS: Ebolavirus is susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for ≥10 minutes) of 5.25% household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder) Footnote 48 Footnote 49 Footnote 50 Footnote 62 Footnote 63. The WHO recommendations for cleaning up spills of blood or body fluids suggest flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that can tolerate stronger bleach solutions (e.g., cement, metal) Footnote 62. For surfaces that may corrode or discolour, they recommend careful cleaning to remove visible stains followed by contact with a 1:100 dilution of 5.25% household bleach for more than 10 minutes.

3% acetic acid: the acid most commonly associated with vinegar. Most vinegar is somewhere between 4 – 8% acetic acid. Vinegar. Ebolavirus is susceptible to vinegar. And alcohol based cleansers. And household bleach. You don’t necessarily need exotic cleanser to kill it on surfaces.

 

PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating for 30 minutes to 60 minutes at 60°C, boiling for 5 minutes, or gamma irradiation (1.2 x106 rads to 1.27 x106 rads) combined with 1% glutaraldehyde Footnote 10 Footnote 48 Footnote 50. Ebolavirus has also been determined to be moderately sensitive to UVC radiation Footnote 51.

60 degrees Celcius = about 140 degrees Fahrenheit.

 

SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C) Footnote 52 Footnote 61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature Footnote 61.  In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20 and 250C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days Footnote 61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting.

A study on transmission of ebolavirus from fomites in an isolation ward concludes that the risk of transmission is low when recommended infection control guidelines for viral hemorrhagic fevers are followed Footnote 64. Infection control protocols included decontamination of floors with 0.5% bleach daily and decontamination of visibly contaminated surfaces with 0.05% bleach as necessary.

 

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Definitive diagnosis can be reached rapidly in an appropriately equipped laboratory using a multitude of approaches, including RT-PCR to detect viral RNA, ELISA based techniques to detect anti-Ebola antibodies or viral antigens, immunoelectron microscopy to detect ebolavirus particles in tissues and cells, and indirect immunofluorescence to detect antiviral antibodies Footnote 1 Footnote 2 Footnote 14 Footnote 41. Note: All diagnostic methods are not necessarily available in all countries.

Definitive diagnosis through blood test.

 

FIRST AID/TREATMENT: There is no effective antiviral treatment Footnote 27 Footnote 37. Instead, treatment is supportive, and is directed at maintaining organ function and electrolyte balance and combating haemorrhage and shock Footnote 22 Footnote 55.

Treatment is SUPPORTIVE. They try to keep your body going while your immune system finds its feet and mounts a defense against the virus.

 

IMMUNIZATION: None Footnote 27.

PROPHYLAXIS: None. Management of the Ebola virus is solely based on isolation and barrier-nursing with symptomatic and supportive treatments Footnote 8.

Isolation (and social distancing). “Barrier-nursing” means wearing personal protective equipment and not getting exposed to infected fluids or tissues.

 

PRIMARY HAZARDS: Accidental parenteral inoculation, respiratory exposure to infectious aerosols/droplets, and/or direct contact with skin or mucous membranes Footnote 54.

You get it by breathing or ingesting infectious fluids or tissues (blood, saliva, tears, sweat, mucus, semen, feces, vomit, etc.), or by having those things in contact with your mucous membranes. 

UPDATED: August 2014.

PREPARED BY: Centre for Biosecurity, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©

Public Health Agency of Canada, 2014
Canada

 

REFERENCES

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Footnote 2

Acha, P. N., & Szyfres, B. (2003). In Pan American Health Organization (Ed.), Zoonoses and Communicable Diseases Common to Man and Animals (3rd ed., pp. 142-145). Washington D.C.: Pan American Health Organization.

Footnote 3

International Committee on Taxonomy of Viruses (2013 Release). Virus Taxonomy. Ebolavirus. http://www.ictvonline.org/virusTaxonomy.asp

Footnote 4

Kuhn, J. H., Becker, S., Ebihara, H., Geisbert, T. W., Johnson, K. M., Kawaoka, Y., Lipkin IW, Negredo AI, Netesov SV, Nichol ST, Palacios G, Peters CJ, Tenorio A, Volchokov VE, & Jahrling, P. B. (2010). Proposal for a revised taxonomy of the family Filoviridae: classification, names of taxa and viruses, and virus abbreviations. Archives of virology, 155(12), 2083-2103.

Footnote 5

Sanchez, A. (2001). Filoviridae: Marburg and Ebola Viruses. In D. M. Knipe, & P. M. Howley (Eds.), Fields virology (4th ed., pp. 1279-1304). Philadelphia, PA.: Lippencott-Ravenpp.

Footnote 6

Takada, A., & Kawaoka, Y. (2001). The pathogenesis of Ebola hemorrhagic fever. Trends in Microbiology, 9(10), 506-511.

Footnote 7

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Footnote 8

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Footnote 9

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Footnote 10

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Footnote 11

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Footnote 12

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Footnote 13

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Footnote 14

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Footnote 15

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Footnote 16

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Footnote 17

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Footnote 18

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Footnote 19

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Footnote 20

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Footnote 21

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Footnote 22

Bausch, D. G., Jeffs B.S.A.G, & Boumandouki, P. (2008). Treatment of Marburg and Ebola haemorrhagic fevers: a strategy for testing new drugs and vaccines under outbreak conditions. Antiviral Res., 78(1), 150-161.

Footnote 23

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Footnote 24

WHO Disease Outbreak News – Ebola Haemorrhagic Fever in Uganda – Update. (2007). 2008

Footnote 25

Formenty, P., Boesch, C., Wyers, M., Steiner, C., Donati, F., Dind, F., Walker, F., & Le Guenno, B. (1999). Ebola virus outbreak among wild chimpanzees living in a rain forest of Cote d’Ivoire. The Journal of Infectious Diseases, 179 Suppl 1, S120-6. doi:10.1086/514296.

Footnote 26

Bray, M. (2003). Defense against filoviruses used as biological weapons. Antiviral Research, 57(1-2), 53-60.

Footnote 27

Leroy, E. M., Rouquet, P., Formenty, P., Souquière, S., Kilbourne, A., Froment, J., Bermejo, M., Smit, S., Karesh, W., Swanepoel, R., Zaki, S. R., & Rollin, P. E. (2004). Multiple Ebola Virus Transmission Events and Rapid Decline of Central African Wildlife. Science, 303(5656), 387-390.

Footnote 28

Nfon, C. K., Leung, A., Smith, G., Embury-Hyatt, C., Kobinger, G., & Weingartl, H. M. (2013). Immunopathogenesis of severe acute respiratory disease in Zaire ebolavirus-infected pigs. PloS one, 8(4), e61904.

Footnote 29

Kobinger, G. P., Leung, A., Neufeld, J., Richardson, J. S., Falzarano, D., Smith, G., Tierney, K., Patel, A., & Weingartl, H. M. (2011). Replication, pathogenicity, shedding, and transmission of Zaire ebolavirus in pigs. Journal of Infectious Diseases, jir077.

Footnote 30

Marsh, G. A., Haining, J., Robinson, R., Foord, A., Yamada, M., Barr, J. A., Payne, J., White, J., Yu, M., Bingham, J., Rollin, P. E., Nichol, S. T., Wang, L-F., & Middleton, D. (2011). Ebola Reston virus infection of pigs: clinical significance and transmission potential. Journal of Infectious Diseases, 204(suppl 3), S804-S809.

Footnote 31

Morris, K. (2009). First pig-to-human transmission of Ebola Reston virus.9(3), 148.

Footnote 32

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Footnote 33

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Footnote 34

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Footnote 35

Connolly, B. M., Steele, K. E., Davis, K. J., Geisbert, T. W., Kell, W. M., Jaax, N. K., & Jahrling, P. B. (1999). Pathogenesis of experimental Ebola virus infection in guinea pigs. The Journal of Infectious Diseases, 179 Suppl 1, S203-17.

Footnote 36

Ebihara, H., Zivcec, M., Gardner, D., Falzarano, D., LaCasse, R., Rosenke, R., Long, D., Haddock, E., Fischer, E., Kawaoka, Y., & Feldmann, H. (2012). A Syrian golden hamster model recapitulating Ebola hemorrhagic fever. Journal of Infectious Diseases, jis626.

Footnote 37

Leroy, E. M., Kumulungui, B., Pourrut, X., Rouquet, P., Hassanin, A., Yaba, P., Délicat, A., Paweska, J. T., Gonzalez, J., & Swanepoel, R. (2005). Fruit bats as reservoirs of Ebola virus. Nature, 438(7068), 575-576.

Footnote 38

Hayman, D. T., Yu, M., Crameri, G., Wang, L. F., Suu-Ire, R., Wood, J. L., & Cunningham, A. A. (2012). Ebola virus antibodies in fruit bats, Ghana, West Africa. Emerging infectious diseases, 18(7), 1207.

Footnote 39

Yuan, J., Zhang, Y., Li, J., Zhang, Y., Wang, L. F., & Shi, Z. (2012). Serological evidence of ebolavirus infection in bats, China. Virol. J, 9, 236.

Footnote 40

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Footnote 41

Franz, D. R., Jahrling, P. B., Friedlander, A. M., McClain, D. J., Hoover, D. L., Bryne, W. R., Pavlin, J. A., Christopher, G. W., & Eitzen, E. M. (1997). Clinical recognition and management of patients exposed to biological warfare agents. Jama, 278(5), 399-411.

Footnote 42

Arthur, R. R. (2002). Ebola in Africa–discoveries in the past decade. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 7(3), 33-36.

Footnote 43

Hewlett, B. S., & Amolat, R. P. (2003). Cultural contexts of Ebola in Northern Uganda. Emerging Infectious Diseases, 9(10), 1242-1248.

Footnote 44

Reed, D. S., Lackemeyer, M. G., Garza, N. L., Sullivan, L. J., & Nichols, D. K. (2011). Aerosol exposure to Zaire ebolavirus in three nonhuman primate species: differences in disease course and clinical pathology. Microbes and Infection, 13(11), 930-936.

Footnote 45

Twenhafel, N. A., Mattix, M. E., Johnson, J. C., Robinson, C. G., Pratt, W. D., Cashman, K. A., Wahl-Jensen, V., Terry, C., Olinger, G. G., Hensley, L. E., & Honko, A. N. (2012). Pathology of experimental aerosol Zaire ebolavirus infection in rhesus macaques. Veterinary Pathology Online, 0300985812469636.

Footnote 46

Weingartl, H. M., Embury-Hyatt, C., Nfon, C., Leung, A., Smith, G., & Kobinger, G. (2012). Transmission of Ebola virus from pigs to non-human primates. Scientific reports, 2.

Footnote 47

Stansfield, S. K., Scribner, C. L., Kaminski, R. M., Cairns, T., McCormick, J. B., & Johnson, K. M. (1982). Antibody to Ebola virus in guinea pigs: Tandala, Zaire. The Journal of Infectious Diseases, 146(4), 483-486.

Footnote 48

Mitchell, S. W., & McCormick, J. B. (1984). Physicochemical inactivation of Lassa, Ebola, and Marburg viruses and effect on clinical laboratory analyses. Journal of Clinical Microbiology, 20(3), 486-489.

Footnote 49

Elliott, L. H., McCormick, J. B., & Johnson, K. M. (1982). Inactivation of Lassa, Marburg, and Ebola viruses by gamma irradiation. Journal of Clinical Microbiology, 16(4), 704-708.

Footnote 50

World Health Organization. Interim Infection Control Recommendationsfor Care of Patients with Suspected or Confirmed Filovirus (Ebola, Marburg) Haemorrhagic Fever. March 2008

Footnote 51

Sagripanti, J. L., & Lytle, C. D. (2011). Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Archives of virology, 156(3), 489-494.

Footnote 52

Belanov, E. F., Muntianov, V. P., Kriuk, V., Sokolov, A. V., Bormotov, N. I., P’iankov, O. V., & Sergeev, A. N. (1995). [Survival of Marburg virus infectivity on contaminated surfaces and in aerosols]. Voprosy virusologii, 41(1), 32-34.

Footnote 53

Sagripanti, J-L., Rom, A.M., Holland, L.E. (2010) Persistence in darkness of virulent alphaviruses, Ebola virus, and Lass virus deposited on solid surfaces. Arch Virol. 155: 2035-9.

Footnote 54

Biosafety in Microbiological and Biomedical Laboratories (BMBL) (2007). In Richmond J. Y., McKinney R. W. (Eds.), . Washington, D.C.: Centers for Disease Control and Prevention.

Footnote 55

Clark, D. V., Jahrling, P. B., & Lawler, J. V. (2012). Clinical Management of Filovirus-Infected Patients. Viruses, 4(9), 1668-1686.

Footnote 56

Emond, R. T. D., Evans, B., Bowen, E. T. W., & Lloyd, G. (1977). A case of Ebola virus infection. British Medical Journal, 2(6086), 541-544.

Footnote 57

Formenty, P., Hatz, C., Le Guenno, B., Stoll, A., Rogenmoser, P., & Widmer, A. (1999). Human infection due to Ebola virus, subtype Cote d’Ivoire: Clinical and biologic presentation. Journal of Infectious Diseases, 179(SUPPL. 1), S48-S53.

Footnote 58

Human pathogens and toxins act. S.C. 2009, c. 24, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009. (2009).

Footnote 59

Rowe AK, Bertolli J,Khan AS,et al. Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidemies à Kikwit. J Infect Dis 1999;179 (Suppl 1):S28-35.

Footnote 60

Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of Ebola virus during the outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis 1999;179 (Suppl 1):S170-6.

Footnote 61

Piercy, T.J., Smither, S.J., Steward, J.A., Eastaugh, L., Lever, M.S. (2010) The survival of filoviruses in liquids, on solid substrates and in a dynamic aerosol. J Appl Microbiol. 109(5): 1531-9.

Footnote 62

World Health Organization (2010). WHO best practices for injections and related procedures toolkit. March 2010. http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf?ua=1

Footnote 63

World Health Organization (2014). Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola. August 2014.
http://www.who.int/csr/resources/who-ipc-guidance-ebolafinal-09082014.pdf

Footnote 64

Baush, D.G., Towner, J.S., Dowell, S.F., Kaducu, F., Lukwiya, M., Sanchez, A., Nichol, S.T., Ksiazek, T.G., Rollin, P.E. (2007) Assessment of the Risk of Ebola virus Transmission from Bodily Fluids and Fomites. JID. 196 (Suppl 2).

 

 

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