Ebola virus disease

Background

• An RNA based virus from the Filovirus Family with 5 species mainly originating from Africa.
• Outbreaks in Gabon, Africa occured in 1996 and in July, 2014
• Viral hemorrhagic fever
• Unknown reservoir with most likely being bats

2014 Outbreak Details

• No confirmed cases diagnosed via US transmission as of 9/10/14
• Outbreak includes
  • Cities of:
    • Port Harcourt, Nigeria
    • Lagos, Nigeria
    • Dakar, Senegal
  • Countries of:
    • Guinea
    • Liberia
    • Sierra Leone

2014 Domestic Outbreak Details

• September 20
  • Index case arrives in Dallas from Liberia
• September 25 & 28
  • Index case visits hospital
• September 30
  • first U.S. diagnosis of Ebola (index patient)
• October 8
  • Index patient dies
  • CDC implements enhanced entry screening at five U.S. airports
• October 10
  • A healthcare worker who cared for index patient tests positive
• October 14
  • A second healthcare worker tests positive for Ebola
  • CDC establishes a dedicated response team for confirmed cases

Communicable Transmission

• Via blood and body fluids (urine, saliva, semen, feces, vomit) in contact with mucous membranes or via instruments such as needles

Clinical Features

• Severe, often fatal (40-65%) hemorrhagic fever
• Incubation period: 2-21 days (most commonly 8-10)
• Common symptoms:
  • Influenza-like Illness: fever, headaches, myalgias, malaise, diarrhea, vomiting, abdominal pain, anorexia
  • Hemorrhagic symptoms: unexplained bleeding/bruising

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Workup

CDC Eval for Ebola in a Traveler

• For travelers returning from countries with active Ebola follow theCDC Algorithm for Evaluation of the Returned Traveler

Persons under Investigation (PUI)

• Obtain a travel history for all persons presenting with fever
• Consider Ebola in any person who presents within 21 days of traveling to an epidemic area
  • During evaluation isolate with standard, contact, and droplet precautions
• Immediately to the PUIs to local health authorities or CDD
  • Los Angeles repots to Acute Communicable Disease Control Program (ACDC) at 213-240-7941 (nights/weekends: 213-974-1234)
  • Special diagnostic testing requires consultation

Diagnostics

A few days after infectious symptoms begin, ELISA IgM, PCR or virus isolation are possible. Later in the disease or during recovery, IgM or IgG can be tested.

Management

• Isolation precautions: standard, contact and droplet
  • Isolate in a single room with the door closed
  • Limit entry and maintain a log of people who enter the room
  • Use standard, contact, and droplet precautions
• Test and treat for other possible causes of Fever in Travelers while evaluating for Ebola
  • CDC has guidance for safe specimen handling
• Supportive care
  • Currently no non-experimental medications directed at the Ebola virus, although newer medications are under evaluation

Disposition

Admit, isolation, possible ICU for serologic results and clinical observation/supportive care.

See Also

• Fever in Travelers
• Travel Medicine
• Viral Hemorrhagic Fevers

External Links

http://www.cdc.gov/vhf/ebola/index.html