Ebola virus disease: Difference between revisions
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*Unknown reservoir with most likely being bats
*Unknown reservoir with most likely being bats


===2014 Country Details<ref>CDC Website, accessed 12/10/2014</ref>===
===2014 Outbreak Country Details<ref>CDC Website, accessed 12/10/2014</ref>===
*Widespread Transmission
*'''Widespread Transmission'''
**Guinea
**Guinea
**Liberia
**Liberia
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==Workup==
==Workup==
[[File:Ed-algorithm-management-patients-possible-ebola.jpg|thumb|ED management algorythm]]
[[File:Ed-algorithm-management-patients-possible-ebola.jpg|thumb|ED management algorythm]]
*For travelers returning from countries with active Ebola follow the [[:File:ebola-algorithm.pdf|CDC Algorithm for Evaluation of the Returned Traveler]]
*For travelers returning from countries with active Ebola follow the [[:File:Ed-algorithm-management-patients-possible-ebola.jpg|CDC Algorithm for Evaluation of the Returned Traveler]]
 
===Persons under Investigation (PUI)===
===Persons under Investigation (PUI)===
*Obtain a travel history for all persons presenting with fever
*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
*Consider Ebola in any person who presents '''within 21 days''' of:
**During evaluation isolate with standard, contact, and droplet precautions
**Traveling to an area with '''widespread transmission''' (see background section), OR
*Immediately to the PUIs to local health authorities or CDD
**Had contact with a person who had a confirmed Ebola case
**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===
==Management<ref>CDC website, accessed 12/10/14</ref>==
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<ref>CDC website, accessed 10/15/14</ref>==
===Transmission Precautions===
===Transmission Precautions===
*Isolate the patient
*Isolate the patient
**single patient room (with private bathroom), door closed
**single patient room (with private bathroom), door closed
*Wear appropriate PPE  
*Wear appropriate PPE  
**Use combination of standard, contact, and droplet [[isolation precautions]]
**Enhanced standard, contact, and droplet [[isolation precautions]]<ref>http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html</ref>
**gloves, gown (fluid resistant or impermeable), eye protection, and a facemask.  
**gloves, gown (fluid resistant or impermeable), eye protection, and a facemask.  
**Additional protective equipment might be required in certain situations: double gloving, disposable shoe covers, and leg coverings
**Additional protective equipment might be required in certain situations: double gloving, disposable shoe covers, and leg coverings
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**Diligent environmental cleaning and disinfection
**Diligent environmental cleaning and disinfection


===Clinical Care===
===Contact Public Health===
*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
 
==Clinical Care==
*Test and treat for other possible causes of [[Fever in Travelers]] while evaluating for Ebola
*Test and treat for other possible causes of [[Fever in Travelers]] while evaluating for Ebola
**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.
*CDC has guidance for safe specimen handling
*CDC has guidance for safe specimen handling
**Use point-of-care testing as much as possible
**Use point-of-care testing as much as possible

Revision as of 20:08, 12 December 2014

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[1]
  • Viral hemorrhagic fever
  • Unknown reservoir with most likely being bats

2014 Outbreak Country Details[2]

  • Widespread Transmission
    • Guinea
    • Liberia
    • Sierra Leone
  • Localized Transmission^
    • United States
    • Mali
  • Previously Affected*
    • Nigeria
    • Senegal
    • Spain

^Persons traveling from these countries should NOT be considered to be at risk for exposure to Ebola.

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[3]

Clinical Features[4]

  • Severe, often fatal (40-65%) hemorrhagic fever
  • Incubation period: 2-21 days (most commonly ~11 days)
  • Patients under the age of 21 years have alower case fatality rate than those over the age of 45 years (57% vs. 94%)[5]
  • Common symptoms:

Differential Diagnosis

Fever in traveler

Workup

ED management algorythm

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 area with widespread transmission (see background section), OR
    • Had contact with a person who had a confirmed Ebola case

Management[6]

Transmission Precautions

  • Isolate the patient
    • single patient room (with private bathroom), door closed
  • Wear appropriate PPE
    • Enhanced standard, contact, and droplet isolation precautions[7]
    • gloves, gown (fluid resistant or impermeable), eye protection, and a facemask.
    • Additional protective equipment might be required in certain situations: double gloving, disposable shoe covers, and leg coverings
    • Have a second party monitor
  • Restrict visitors
    • Avoid entry of visitors into the patient's room
    • Keep a logbook of all persons entering the patient's room
  • Avoid aerosol-generating procedures
    • If necessary, use respiratory protection (N95 or higher) and perform in airborne isolation room
  • Implement environmental infection control measures
    • Diligent environmental cleaning and disinfection

Contact Public Health

  • 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

Clinical Care

  • Test and treat for other possible causes of Fever in Travelers while evaluating for Ebola
    • 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.
  • CDC has guidance for safe specimen handling
    • Use point-of-care testing as much as possible
  • Supportive care

Disposition

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

See Also

External Links

Sources

  1. ↑ Ebola Virus Disease, West Africa http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4233-ebola-virus-disease-west-africa-25-july-2014.html.
  2. ↑ CDC Website, accessed 12/10/2014
  3. ↑ Peters CJ. Chapter 197. Ebola and Marburg Viruses. Harrison’s Principles of Internal Medicine, 18e. 2012
  4. ↑ Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. N Engl J Med 2014;371:1481-95
  5. ↑ Schieffelin JS, Shaffer JG, Goba A, et al. Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. N Engl J Med. 2014 Oct 29. PMID 25353969
  6. ↑ CDC website, accessed 12/10/14
  7. ↑ http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
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