Republic of the Philippines

University of Northern Philippines

Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

COMMUNITY & PUBLIC HEALTH

EBOLA VIRUS DISEASE

(A report paper presented to Fitz Gerald P. Castillo, RMT)
I. EPIDEMIOLOGY
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a rare but severe, often fatal
illness in humans.
The Ebola virus causes an acute, serious illness which is often fatal if untreated. EVD was first
discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo. Since then,
the virus has been infecting people from time to time, leading to outbreaks in several African countries.
The 2014–2016 outbreak in West Africa was the largest Ebola outbreak since when the virus was
discovered. The outbreak started in Guinea and then moved across land borders to Sierra Leone and
Liberia. The current 2018-2019 outbreak in eastern DRC is highly complex, with insecurity adversely
affecting public health response activities.
Occurs mainly in areas surrounding rain forests in central Africa (6) with the exception of Reston which
occurs in the Philippines (9). No predispositions to infection have been identified among infected
victims; however, the 20 – 30-year-old age group seems to be particularly susceptible.
The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in
past outbreaks.

II. PATHOPHYSIOLOGY
Ebola virus disease (EVD) is caused by an infection with a group of viruses within the genus Ebola virus:
Zaire virus
Sudan virus
Taï Forest virus (formerly and perhaps still more commonly Ivory Coast ebolavirus; Côte d’Ivoire
ebolavirus)
Bundibugyo virus
Reston virus
Bombali virus

Of these, only four (Ebola, Sudan, Taï Forest, and Bundibugyo viruses) are known to cause disease in
people. Reston virus is known to cause disease in nonhuman primates and pigs, but not in people. It is unknown
if Bombali virus, which was recently identified in bats, causes disease in either animals or people.
Filoviruses such as Ebola virus share a characteristic filamentous form, with a uniform diameter of
approximately 80 nm but a highly variable length. Filaments may be straight, but they are often folded on
themselves.
Ebola virus enters the patient through mucous membranes, breaks in the skin, or parenterally and infects
many cell types, including monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes,
adrenal cortical cells, and epithelial cells. The incubation period may be related to the infection route (6 days for
injection versus 10 days for contact). Ebola virus migrates from the initial infection site to regional lymph nodes

EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)

EDJEAN JLIAN C. CORPUZ
 Republic of the Philippines
University of Northern Philippines
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

and subsequently to the liver, spleen, and adrenal gland. Although not infected by Ebola virus, lymphocytes
undergo apoptosis resulting in decreased lymphocyte counts. Hepatocellular necrosis occurs and is associated
with deregulation of clotting factors and subsequent coagulopathy. Adrenocortical necrosis also can be found
and is associated with hypotension and impaired steroid synthesis. Ebola virus appears to trigger a release of
pro-inflammatory cytokines with subsequent vascular leak and impairment of clotting ultimately resulting in
multi-organ failure and shock.
III. CASE DEFINITION
Ebola virus disease (EVD) is a rare and deadly viral illness. Early recognition is critical to
controlling the spread of Ebola virus. Healthcare providers should evaluate the patient’s epidemiologic risk,
including a history of travel to a country with Ebola transmission or contact within the preceding 21 days
with a person with Ebola while the person was symptomatic. Health-care providers should be alert for and
evaluate any patients suspected of having EVD.
Person Under Investigation (PUI)
CLINICAL DESCRIPTION: A person who has both consistent signs or symptoms and risk factor (an
epidemiologic risk factor within the 21 days before the onset of symptoms).
CLINICAL MANIFESTATIONS: Elevated body temperature or subjective fever or symptoms,
including severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained
haemorrhage.
Confirmed Case
CLINICAL DESCRIPTION: Laboratory-confirmed diagnostic evidence of Ebola virus infection.
CLINICAL MANIFESTATIONS: Severe sore throat, chest and abdominal pain, skin rash, diarrhea,
vomiting, followed by haemorrhage, hiccups, somnolence, delirium and coma.

IV. SPREAD OF INFECTION

The virus is transmitted to people from wild animals and spreads in the human population.
INCUBATION PERIOD: 2 - 21 days
MODE OF TRANSMISSION:
1. Virus reservoir: fruit bats
The virus maintains itself in fruit bats
2. Epizootics in animals
Infected fruit bats enter in direct or indirect contact with other animals and pass on the infection.
Large-scale epidemics in primates or mammals (e.g. forest antelopes) can happen.
3. Primary human transmission
Humans are infected either through: handling infected dead or sick animals found in the forest or
through direct contact with infected bats
4. Secondary human transmission
Secondary human-to-human transmission occurs through direct contact with the blood, secretions,
organs or other body fluids of infected persons; also in providing direct patient care or handling dead
bodies (funerals).
5. Virus persistence

EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)

EDJEAN JLIAN C. CORPUZ
 Republic of the Philippines
University of Northern Philippines
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

Persistence of Ebola virus in body fluids of EVD survivors represents a risk for sexual transmission.
PERIOD OF COMMUNICABILITY
Communicable as long as blood, secretions, organs, or semen contain the virus. Ebola virus has
been isolated from semen 61 days after the onset of illness, and transmission through semen has
occurred 7 weeks after clinical recovery.

V. LABORATORY TEST FOR DIAGNOSIS

There is no test available to detect Ebola before symptoms begin. It can take up to three days after the start of
symptoms to detect the virus, so some individuals may need to be tested more than once to avoid false-negative
results. The WHO and the CDC recommend molecular testing and antigen ELISA testing for diagnosing acute
Ebola. The WHO recommends initial testing with a rapid point-of-care test when there is no molecular testing
available for triage during an outbreak.
SCREENING & CONFIRMATORY TEST
NAME OF TEST: antibody-capture enzyme-linked immunosorbent assay (ELISA)
ABOUT THE TEST: ELISA is used in both experimental and diagnostic virology. It is a highly sensitive
assay
that can detect proteins at the picomolar to nanomolar range (10-12 to 10-9 moles per liter).
TEST PRINCIPLE: immunoassay, genetically modifies genes, proteins, monoclonal antibody, and viral-
antigen based EBOV detection approach
INTENDED USE: may be used to diagnose: HIV, which causes AIDS; Lyme disease, pernicious anemia,
Rocky
Mountain spotted fever, rotavirus, squamous cell carcinoma, syphilis, toxoplasmosis, varicella-
zoster virus, which causes chickenpox and shingles, Zika virus
SPECIMEN TYPE: blood
TEST INTERPRETATION: You may have the condition if the contents of the dish change color. How
much
changes the enzyme cause allows the technician to determine the presence and amount of antibody.
TEST LIMITATIONS: The needs of BSL-4 facility to perform Ebola detection and diagnostics using these
methods limit application of these techniques in field.
EXPECTED RESULTS: Positive, Negative; False positives and false negatives can also occur.
A false-positive result indicates you have a condition when you actually don’t. A false-negative result indicates you
don’t have a condition when you actually do. Because of this, you may be asked to repeat the ELISA again in a few
weeks, or your doctor may order more sensitive tests to confirm or refute the results.
Other tests for detection/confirmation of Ebola virus:
antigen-capture detection tests
serum neutralization test
reverse transcriptase polymerase chain reaction (RT-PCR) assay
electron microscopy
virus isolation by cell culture

VI. TREATMENT, CURE OR MEDICAL MANAGEMENT

Symptoms of Ebola virus disease (EVD) are treated as they appear. When used early, basic
interventions can significantly improve the chances of survival. These include:

EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)

EDJEAN JLIAN C. CORPUZ
 Republic of the Philippines
University of Northern Philippines
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

Providing fluids and electrolytes (body salts) through infusion into the vein (intravenously).
Offering oxygen therapy to maintain oxygen status.
Using medication to support blood pressure, reduce vomiting and diarrhea and to manage fever and pain.
Treating other infections, if they occur.
Antiviral Drugs
Drugs that are being developed to treat EVD work by stopping the virus from making copies of itself.
Vaccines
An experimental Ebola vaccine proved highly protective against EVD in a major trial in Guinea in 2015.
The vaccine, called rVSV-ZEBOV, was studied in a trial involving 11841 people. Among the 5837 people who
received the vaccine, no Ebola cases were recorded 10 days or more after vaccination. In comparison, there were
23 cases 10 days or more after vaccination among those who did not receive the vaccine.
The rVSV-ZEBOV vaccine is being used in the on-going 2018-2019 Ebola outbreak in DRC. Pregnant and
breastfeeding women should have access to the vaccine under the same conditions as for the general population.
VII. INFECTION CONTROL MEASURES
Health-care workers should always take standard precautions when caring for patients, regardless of their
presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment
(to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection
control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials
such as clothing and bedding. When in close contact (within 1 metre) of patients with EVD, health-care workers
should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown,
and gloves (sterile gloves for some procedures).
INFECTION CONTROL PROTOCOL
Medical Practitioners/Professions
Guidance from the CDC recommends that healthcare personnel who care for patients infected with
Ebola virus (ie, physicians, nurses, other clinicians) wear personal protective equipment (PPE) that does
not expose any skin. This includes a surgical hood that covers the head and neck and a single-use full
face shield (rather than goggles), in addition to either a N95 respirator or powered air-purifying
respirator instead of a mask.
The CDC now recommends that clinicians train rigorously at donning and doffing PPE in a stepwise
manner and demonstrate competency. A trained monitor should oversee each time a clinician puts on
and takes off this gear.
During patient care, the PPE should not be adjusted, and the worker’s gloved hands should be
disinfected frequently using an alcohol-based hand rub (ABHR), especially after body fluids are
handled.
Laboratory Setting
Collection of Specimens
Specimens should be obtained when a patient meets the criteria for person under investigation (PUI)
including patients with clinical signs, symptoms, and epidemiologic risk factors for Ebola virus
disease. If the first specimen is obtained 1-3 days after the onset of symptoms and tests negative and

EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)

EDJEAN JLIAN C. CORPUZ
 Republic of the Philippines
University of Northern Philippines
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

the patient remains symptomatic without another diagnosis, a later specimen is needed to rule-out
Ebola virus infection.
Staffs who collect specimens from PUIs should wear appropriate PPE and be knowledgeable in
procedures for putting on (donning) and removing (doffing).
For adults, a minimum volume of 4 mL whole blood is preferable. For pediatric samples, a
minimum of 1 mL whole blood should be collected in pediatric-sized collection tubes. Blood must
be collected in plastic collection tubes. Do not transport or ship specimens in glass containers or in
heparinized tubes.
Whole blood preserved with EDTA is preferred, but whole blood preserved with sodium
polyanethol sulfonate, citrate or with clot activator is also acceptable.
Do not separate and remove serum or plasma from the primary collection container.
Specimens should be packaged and transported at 2°–8°C with cold-packs to the final testing
destination.
Specimens other than blood may be submitted after consultation with CDC.
Storing Clinical Specimens for Ebola Testing
If necessary, short-term storage of specimens before shipping should be at 4°C or frozen.
Transporting Specimens Within the Facility
PPE to be worn during transport within the facility should be determined by a site-specific risk
assessment, and may vary among facilities. Recommendations for PPE include disposable fluid-
resistant closed lab coat, disposable gloves, covered legs and closed-toed shoes.
Before removing patient specimens from the site of care, it is advisable to plan the route of the
sample from the patient area to the location where it will be packed for shipping to avoid high traffic
areas.
Before removing patient specimens from the site of care, the outside of the specimen containers
should be decontaminated with an approved disinfectant.
In compliance with OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030), specimens should
be placed in a durable, leak-proof secondary container.
After placing in a secondary container, specimens should be hand-carried to the laboratory or
packing area. DO NOT use any pneumatic tube system (automated or vacuum specimen delivery
system) for transporting specimens.
Transporting Specimens for Ebola Testing to Sites Outside the Facility
Samples from patients who are PUIs or confirmed to have Ebola virus infection should be packaged
and shipped as Category A infectious substances.
All persons packing and shipping infectious substances must be trained and certified in compliance
with DOT or the International Air Transport Association (IATA) requirements every two years.
Specimens collected for Ebola virus testing should be packed and shipped without attempting to
open collection tubes or aliquot specimens. Opening the tubes destroys the vacuum seal and thus
increases the risk of leakage during transport.
Specimens for shipment should be packaged following the basic triple packaging system, which
consists of (1) a primary container (a sealable specimen container) wrapped with absorbent material,
(2) a secondary container (watertight, leak-proof), and (3) an outer shipping package.
Ebola-Associated Waste Management
EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)
EDJEAN JLIAN C. CORPUZ
 Republic of the Philippines
University of Northern Philippines
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

Waste contaminated (or suspected to be contaminated) with Ebola virus is a Category A infectious
substance regulated as a hazardous material under the U.S. Department of Transportation (DOT)
Hazardous Materials Regulations (HMR; 49 CFR, Parts 171-180).
Inactivation or incineration of Ebola-associated waste within a hospital system may be subject to
state, local, and OSHA regulations.
 On-site inactivation: Ebola-associated waste may be inactivated through the use of
appropriate autoclaves.
 On-site incineration: Ebola-associated waste may be incinerated. The products of
incineration (i.e., the ash) can be transported and disposed of in accordance with state and
local regulations and standard protocols for hospital waste disposal.

REFERENCES:
• World Health Organization. (2020). Ebola virus disease. Retrieved from https://www.who.int/news-
room/fact-sheets/detail/ebola-virus-disease on March 19, 2020.
• World Health Organization. (2020). Introduction to Ebola virus disease. Retrieved from
https://www.who.int/
news-room/fact-sheets/detail/ebola-virus-disease on March 19, 2020.
• Centers for Disease Control and Prevention. (2019, November 5). Ebola virus disease. Retrieved from
https://www.cdc.gov/vhf/ebola/index.html on March 19, 2020.
• Centers for Disease Control and Prevention. (2019, July 9). Case Definition for Ebola Virus Disease
(EVD). Retrieved from https://www.cdc.gov/vhf/ebola/clinicians/evaluating-patients/case-definition
.html on March 19, 2020.
• Centers for Disease Control and Prevention. (2018, May 15). Guidance for Collection, Transport and
Submission of Specimens for Ebola Virus Testing. Retrieved https://www.cdc.gov/vhf/ebola/
laboratory-personnel/specimens.html on March 19, 2020.
• Centers for Disease Control and Prevention. (2019, April 3). Ebola-Associated Waste Management.
Retrieved
from https://www.cdc.gov/vhf/ebola/clinicians/cleaning/waste-management.html on March 19,
2020.
• King, W. et al. (2020, March 3). Ebola virus infection. Retrieved from https://emedicine.medscape.com/
article/216288-overview on March 19, 2020.
• Public Health Agency of Canada. (2010, August). Ebola virus. Retrieved from https://emedicine.medscape
EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)
EDJEAN JLIAN C. CORPUZ
 Republic of the Philippines
University of Northern Philippines
Tamag, Vigan City
2700 Ilocos Sur

COLLEGE OF HEALTH SCIENCES

Website: www.unp.edu.ph email: chs_unp@yahoo.com
Tel No.: +639177708873

.com/article/216288-overview on March 19, 2020.

• Lab Tests Online. (2019, October 9). Ebola virus infection. Retrieved from
https://labtestsonline.org/conditions
/ebola-virus-infection on March 19, 2020.
• Virology Blog. (2010, July 16). Detection of antigens or antibodies by ELISA. Retrieved from
http://www.virology.ws/2010/07/16/detection-of-antigens-or-antibodies-by-elisa/ on March 19,
2020.
• Healthline. (2020). ELISA. Retrieved from https://www.healthline.com/health/elisa on March 19, 2020.

EBOLA VIRUS DISEASE (Ebola Haemorrhagic Fever)

EDJEAN JLIAN C. CORPUZ