Ebola virus disease

Background

An RNA based virus from the Filovirus Family with 5 species mainly originating from Africa.
Viral hemorrhagic fever
Unknown reservoir with most likely being bats

CDH Health Alert for Clinicians 5-19-2026
- US DHS Quarantine Order
- US Airport Screening
WHO Notice 5-17-2026
Currently affected areas:
- Bunia, Rwampara, Mongbwalu, Ituri, & North Kivu DRC
- Kampala, Uganda
Bundibugyo strain (40% historical fatality rate), not Zaire (90% fatality when untreated) or Sudan (50% fatality) strains

Via blood and body fluids (urine, saliva, semen, feces, vomit) in contact with mucous membranes or via instruments such as needles^[1]

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%)^[3]
Common symptoms:
- fever (87.1%)
- fatigue (76.4%)
- Loss of appetite (64.5%)
- vomiting (67.6%)
- diarrhea (65.6%)
- headache (53.4%)
- abdominal pain (44.3%)
- Hemorrhagic symptoms (<43%)

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

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

Isolate the patient
- single patient room (with private bathroom), door closed
Wear appropriate PPE
- Enhanced standard, contact, and droplet isolation precautions^[5]
- 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

Immediately report PUIs to local health authorities or CDC
- Los Angeles repots to Acute Communicable Disease Control Program (ACDC) at 213-240-7941 (nights/weekends: 213-974-1234)
- Special diagnostic testing requires consultation

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

Frontline Healthcare Facilities
- In consultation with public health authorities:
  - Low risk: May initiate testing
  - High risk: Transfer to Ebola Assessment Hospital or Ebola Treatment Center (if locally available)
Ebola Assessment Hospitals
- In consultation with public health authorities:
  - Initiate initial testing
  - If confirmed case, transfer to Ebola Treatment Center^[6]
Ebola Treatment Center
- Admit, isolation, possible ICU for serologic results and clinical observation/supportive care.

↑ Peters CJ. Chapter 197. Ebola and Marburg Viruses. Harrison’s Principles of Internal Medicine, 18e. 2012
↑ Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. N Engl J Med 2014;371:1481-95
↑ 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
↑ CDC website, accessed 12/10/14
↑ http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
↑ http://www.cdc.gov/vhf/ebola/hcp/current-treatment-centers.html