The Latest Information on Ebola

For those looking for authoritative information about Ebola, we offer this from one of the National Network of Libraries of Medicine’s regional offices. Any of Ebling’s librarians are happy to help with additional information.

From: Centers for Disease Control and Prevention (CDC)

· Ebola Hemorrhagic Fever Topics / Resources

· Questions and Answers on Ebola


From:
World Health Organization, this information.

From: National Library of Medicine (NLM) MedlinePlus Resource Guides

· English

· Spanish

From: NLM Disaster Information Management Research Center (DIMRC)

· Resource Guide for Disaster Medicine and Public Health

From: U.S. Joint Commission

· Recommendations for U.S. Hospitals Treating Ebola Patients

We have also received this from UW’s Nasia Safdar, M.D., a Hospital Epidemiologist

In response to the recent outbreak of Ebola in West Africa and the treatment of Ebola cases in the United States, the UWHC Infection Control Department has compiled the following guidance document to aid in the identification and control of Ebola in our facilities. Although, it is unknown and perhaps unlikely that we will see cases of Ebola related to this outbreak in West Africa, it is imperative that we be prepared in the event that we do encounter a patient with suspected or confirmed Ebola. It is also important to note that our hospital design, along with our infection prevention policies and procedures, are adequate to prevent and control Ebola transmission should a case be encountered.

Ebola – Identification and Control

Ebola is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. The subspecies that is causing the current outbreak in West Africa is Ebola virus (Zaire ebolavirus). The natural reservoir for the virus is unknown; however, bats are the most likely reservoir. The mortality ranges from 60 to 90%, there is no vaccine and there is no specific treatment. Healthcare workers are at high risk for contracting illness through contact with infected blood or bodily secretions. Every effort should be made to limit transmission of Ebola in healthcare facilities.

Symptoms and Incubation period

Symptoms may appear anywhere from 2-21 days after exposure though 8-10 days is most common. Individuals are NOT infectious until they are symptomatic.

Case definitions for Ebola

1. Suspected case: Illness in a person who has both consistent symptoms and risk factors as follows:

• Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage;

AND

• Epidemiologic risk factors within the past 3 weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known to have or suspected to have Ebola; residence in—or travel to—an area where Ebola transmission is active (including Guinea, Liberia, Sierra Leone, Nigeria); or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries.

2. Confirmed case: A suspected case with laboratory-confirmed diagnostic evidence of Ebola infection. Source: HAN 364

Transmission: When infection occurs in humans, transmission can occur in the following ways:

• Direct contact with the blood or bodily secretions of an infected symptomatic person. All secretions should be considered infectious.

• Exposure to objects (such as needles) that have been contaminated with infected secretions

• Ebola is not spread through the airborne route, however, airborne precautions are indicate for aerosol-generating procedures such as intubation, extubation, BiPAP, bronchoscopy, sputum induction, open airway suctions. For consistency, UWHC Infection Control is recommending the use of Special Precautions which requires the use of an N-95 mask, Airborne Infection Isolation (AII) negative pressure room and well as face shield, gown, gloves and other personal protective equipment (PPE) as needed.

Infection Control

If patient presents with the following, immediately initiate Special Precautions including the use of an N-95 mask, face shield, gown, gloves and other PPE as needed to avoid all contact with blood and bodily secretions and place in private Airborne Infection Isolation (AII) negative pressure room:

1. Travel in past 21 days to country where Ebola transmission is active; including Guinea, Liberia, Sierra Leone and Nigeria OR contact with person with known Ebola infection

AND

2. Fever of 101.5 or greater

• Since transmission is through infected body fluids all efforts must be made to avoid contact with body fluids through the use of PPE including, gown, gloves, N-95 mask, eye protection and potentially leg and shoe covers depending on the level of exposure risk. Care must be taken to avoid exposure when PPE is removed.

• Hand hygiene must be performed after removal of PPE

• Use of needles and sharps should be limited as much as possible. Contaminated sharps must be handled with extreme care

• Patient care equipment should be dedicated and disposable if possible. All non-dedicated medical equipment should be cleaned and disinfected per hospital policy.

• A log should be maintained of all persons entering the patient’s room and personnel will be posted outside the room to ensure that appropriate use of PPE is observed for all who enter the patient room. Only persons essential to care of the patient should enter the patient’s room. Visitors are not allowed. Only essential blood draws and radiology should be performed on the patient to minimize entry of ancillary support personnel in the room. Transport outside the room should be avoided if possible.

• In the event that an exposure to body fluids occurs, rinse/wash the area immediately and report incident to unit manager and Employee Health Services

Contact UWHC Infection Control at pager 2570 immediately if a patient is suspected of Ebola.

Testing

Virus is not usually detected in the blood immediately; therefore, tests for virus should be delayed until 72 hours after fever onset. If a person has the early symptoms of Ebola and there is reason to believe that Ebola should be considered, the patient should be isolated and Infection Control notified at pager 2570. Samples from the patient can then be collected and tested to confirm infection in coordination with the CDC. Contact the UWHC Clinical Lab for information on testing and specimen transport. Specific guidance on lab testing will follow in a separate communication.

Timeline of infection

Diagnostic tests available

Within a few days after symptoms begin

• Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing

• IgM ELISA

• Polymerase chain reaction (PCR)

• Virus isolation

Later in disease course or after recovery

• IgM and IgG antibodies

Retrospectively in deceased patients

• Immunohistochemistry testing

• PCR

• Virus isolation

Source: CDC

Treatment: Standard treatment for Ebola is still limited to supportive therapy.

Duration of communicability

The duration of communicability is not completely known. Infected patients should remain in isolation until virus is no longer detected in blood. Infection Control will make the decision when to take the patient out of isolation.

Questions: Please contact Nasia Safdar, Hospital Epidemiologist, at af2@zrqvpvar.jvfp.rqh or 608-213-4075.

Ebola 2014

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