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Guidelines EVD August 2014
Guidelines EVD August 2014
Guidelines for
Prevention and Control of Ebola Virus Disease (EVD)
Developed with joint the collaboration of
National Institute of Health, Islamabad
Ministry of National Health Services, Regulation and Coordination
Government of Pakistan and
the World Health Organization
August 2014
Index
Contents
S. #
Page
#
2
1.
Introduction
2.
Infectious agent
3.
Clinical features
4.
5.
Case definition
6.
7.
8.
9.
10.
10
11.
12
References
13
12
Clinical features
Occurrence and
geographical
distribution
Case definition
Alert case:
Illness with onset of fever and no response to treatment of usual
causes of fever in or from the endemic area,
OR
at least one of the following signs:
bleeding, bloody diarrhoea, bleeding into urine OR any sudden death
Suspected Ebola or Marburg cases for routine surveillance:
Illness with onset of fever and no response to treatment for usual
causes of fever in or from the endemic area, and at least one of the
following signs:
bloody diarrhea, bleeding from gums, bleeding into skin (purpura),
bleeding into eyes and urine.
Or
Incubation
period
Case fatality
rate (CFR)
Reservoir
Mode of
transmission
Period of
communicability
Susceptibility
and resistance
Risk factors for
increased
transmission
The case fatality rate (CFR) from Ebola infections in Africa has ranged
from 50% 90%, whereas 25% 80% of the reported cases of Ebola
Marburg viral infection have been fatal.
Fruit Bats are considered the most likely natural reservoir of the EBOV.
Traces of EBOV were detected in the carcasses of gorillas and
chimpanzees during outbreaks in 2001 and 2003, which later became
the source of human infections.
A person infected with Ebola virus is not contagious until symptoms
appear
Virus spreads through direct contact with the bodily fluids (blood,
urine, feces, saliva, and other secretions) of an infected person, or with
objects like needles that have been contaminated with the virus.
Ebola do not spread through the air or by food or water.[10] However,
laboratory generated droplets[12] having 0.81.2 m size are
breathable. Because of this potential route of infection, of these viruses
have been classified as Category A biological weapons.[13]
Can spreads in the community through human-to-human transmission
from direct contact (through broken skin or mucous membranes) with
the blood, secretions, organs or other body fluids of infected people,
and indirect contact with environments contaminated with such fluids.
Through burial ceremonies in which mourners have direct contact with
the body of the deceased
Men who have recovered from the disease can still transmit the virus
through their semen for up to 7 weeks after recovery from illness.
Health-care workers have frequently been infected while treating
patients with suspected or confirmed EVD.
In Africa, infection has been documented through the handling of
infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and
porcupines found ill or dead or in the rainforest.
Nosocomial infections have been frequent.
Epidemic potential can spread from person to person, most often during
the care of patients, which requires strengthening of strict infection
control measures during the management of cases.
Risk during the incubation is low and can increase with stages of illness
as long as blood and secretions contain virus.
Ebola virus was isolated from the seminal fluid on 61st but not on the
76th day after onset of illness in a laboratory acquired case.
The primary care providers in Sudan were infected up to 30% while
most of other house hold contacts remained uninfected.
All ages and genders are susceptible.
Healthcare providers caring for Ebola patients and the family and
friends in close contact with Ebola patients are at the highest risk of
getting sick because they may come in contact with the blood or body
fluids of sick patients.
People also can become sick with Ebola after coming in contact with
infected wildlife
Contacts of cases or individuals with exposure in laboratories are
placed under health surveillance for 21 days after their last exposure to
infection. If become feverish, should undergo risk assessment and may
be admitted to strict isolation pending the results of diagnostic tests.
Lab Sampling
PPE: Full face shield or goggles, masks to cover all of nose and
mouth, gloves, fluid resistant or impermeable gowns. Additional PPE
may be required in certain situations.
Sample collection:
Storage of specimens
Specimens can be stored for two days if preserved in type
specific media at 4-8C. For prolonged storage periods,
preservation at 70C may be indicated.
Specimens for antigen or antibody detection may be stored at 48C for 24-48 hours or at 20C for longer periods. Sera for
antibody detection may be stored at 4-8C for up to 10 days.
Packaging & Transport of specimens
Specimens should be packaged as triple packaging system
which consists of a primary receptacle (a sealable specimen
bag) wrapped with absorbent material, secondary receptacle
7
Cleaning &
decontaminatio
n
Lab diagnosis
Treatment
PCR
Virus isolation
Acute infections will be confirmed using a real-time RT-PCR assay
Serologic testing (IgM and IgG antibodies) are required to monitor the
immune response in confirmed EVD patients
The medical history, especially travel and work history along with
exposure to wildlife are important to suspect the diagnosis of EVD.
Leukopenia with lymphopenia followed later by elevated neutrophils
and a left shift.
Platelet counts are often decreased in the 50,000 to 100,000 range.
Amylase, Hepatic transaminases,
fibrin degradation products,
Prothrombin (PT) and partial thromboplastin times (PTT) may be
elevated
Proteinuria may be present.
Initially exclude common ailments like malaria, typhoid fever,
shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever,
meningitis, hepatitis and other viral hemorrhagic fevers.
No Ebola virus-specific treatment exists. Standard treatment for Ebola
HF is still limited to supportive therapy consists of:
o balancing the patients fluids and electrolytes
o maintaining their oxygen status and blood pressure
o treating them for any complicating infections
Severely ill patients require intensive supportive care.
Early treatment may increase the chance of survival.
Epidemic
measures
High Risk
Percutaneous (e.g., Fever or other Evaluation using IPC for
needle
stick)
or
symptoms
suspected EVD, and
mucous membrane
without fever
testing if indicated
exposure to body
If transport is indicated,
fluids of EVD patient
air medical transport only
Direct care of an
(no public or commercial
EVD
patient
or
conveyances permitted)
exposure to body
Keep under observation
fluids
without
with limited movements
appropriate PPEs
until 21 days after last
Laboratory
worker
known exposure
processing
body
fluids of confirmed Asymptomatic
Conditional release and
EVD patients without
controlled
movement
appropriate PPE or
until 21 days after last
standard biosafety
known exposure
precautions
Participation
in
funeral rites which
include
direct
exposure to human
remains
in
the
geographic
area
where outbreak is
occurring
without
appropriate PPE
Low Risk
Household member Fever with or
without
other
or other casual
symptoms
contact with an
EVD patient
Providing
patient
care
or
casual
contact without highrisk exposure with
EVD patients in
health care facilities
in outbreak-affected
countries
Medical
evaluation
using for suspected
EVD, consultation, and
testing if indicated
If transport is clinically
appropriate & indicated,
air medical transport
only (no public or
commercial
conveyances permitted)
If not found to be
probable
case,
conditional release and
controlled
movement
until 21 days after last
known exposure
Asymptomatic
No Known Exposure
with
In affected country Fever
other
having no low-risk
symptoms
or
high-risk
exposures
Asymptomatic
International
measures
Safety
measures for
health workers,
contacts and
patients
attendants
10
Prevention
and control
11
Travelers
12
Prognosis
References
1. Ebola virus disease Fact sheet World Health Organization.
2. Brown R (2014-07-17). "The virus detective who discovered Ebola in 1976". News Magazine. BBC
News.
3. Bennett D, Brown D (May 1995). "Ebola virus". BMJ (Clinical research ed.) 310 (6991): 13441345.
doi: 10.1136/bmj.310.6991.1344. PMC 2549737.PMID 7787519.
th
4. C.M. Fauquet (2005). Virus taxonomy classification and nomenclature of viruses; 8 report of the
International Committee on Taxonomy of Viruses. Oxford: Elsevier/Academic Press. p. 648.
ISBN 9780080575483.
5. King JW (2008-04-02). "Ebola Virus". eMedicine. WebMd. Retrieved 2008-10-06.
6. Ebola Viral Disease Outbreak West Africa, 2014. CDC. June 27, 2014.
7. CDC urges all US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leone
because of an unprecedented outbreak of Ebola.".CDC. July 31, 2014. Retrieved 2 August 2014.
8. Outbreak of Ebola in Guinea, Liberia, and Sierra Leone. CDC. August 4, 2014. Retrieved 5 August
2014.
9. Ebola virus disease, West Africa update 8 August 2014. WHO. 8 August 2014. Retrieved 8 August
2014.
10. 2014 Ebola Virus Disease (EVD) outbreak in West Africa. WHO. Apr 21 2014. Retrieved 3 August
2014.
11. Ebola Hemorrhagic Fever Signs and Symptoms. CDC. January 28, 2014. Retrieved 2 August 2014.
12. Johnson E, Jaax N, White J, Jahrling P (Aug 1995). Lethal experimental infections of rhesus monkeys
by aerosolized Ebola virus. International journal of experimental pathology 76 (4): 227236.ISSN
0959 -9673. PMC 1997182. PMID 7547435.
13. Leffel EK, Reed DS (2004). Marburg and Ebola viruses as aerosol threats. Biosecurity and
bioterrorism : biodefense strategy, practice, and science 2 (3): 186191.doi:10.1089/ bsp.2004.2.
186. ISSN 1538-7135. PMID 15588056.
14. Ebola Hemorrhagic Fever Diagnosis. CDC. January 28, 2014. Retrieved 3 August 2014.
15. Grolla A, Lucht A, Dick D, Strong JE, Feldmann H (2005). "Laboratory diagnosis of Ebola and
Marburg hemorrhagic fever. Bull Soc Pathol Exot 98 (3): 2059.PMID 16267962.
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