·
Ebola
Virus Disease (EVD)
o
Viral Haemorrhoagic Fever.
§
Outbreaks ’76, ’79, ’84, 95 and several since
2000
o Transmission to humans from wild animals (fruit
bats are thought to be the natural host) and then human-to-human transmission
via direct contact of bodily fluids (via skin or mucous membranes) e.g. blood,
secretions or diarrhoea/vomit and with materials (e.g. surfaces, bedding)
infected with these fluids. Ebola can only be transmitted through direct contact with the body fluids of an infected person. Infected people can excrete the virus in all
bodily fluids e.g. semen and breast milk
o
Case fatality rate is approx. 50%, but is
70% in current outbreak
o
Incubation period ranges from 2 to 21 days, but humans
are not infectious until they develop symptoms
o
First symptoms are ‘flu like’: sudden onset of
fever, fatigue, myalgia, headache and sore throat
§
This is followed by diarrhoea, vomiting, rash
then organ failure and bleeding
o
There are two potential vaccines in development
·
Outbreak
March 2014 significant as large numbers and high mortality rate in
o
Sierra Leone, Guinea and Liberia
o
Declared public health emergency August 2014
§
Over 7500 cases (underestimate as of October
2014)
§
4,000 deaths so far (October 2014)
·
Implications
in the UK
o
Low risk of imported cases at the current time
(Oct 2014). Main risk is from
§
Humanitarian and health care workers returning
home
§
Travel from infected areas. Ebola should be suspected in patients presenting to primary care who have a fever >38 OR a history of fever in the last 24 hours AND have visited affected areas in the previous 21 days OR cared for/been in contact with someone suspected of having Ebola. People that telephone the surgery and fulfil these criteria should NOT be advised to come to the surgery or OOH centre, but be referred to the local hospital trust for review.
Suspect if present with:
Suspect if present with:
§
Fever (or fever in the last 24 hours) AND
§
Have travelled to an infected area (Sierra
Leone, Guinea or Liberia) in the preceding 21 days (or been in contact with
someone who has) OR
§
Has come into contact with body fluids, clinical
specimens from a live or dead person/ animal with suspected Ebola
o
Consider Ebola and take a full travel history.
·
Other presenting
symptoms
o
Fever >38°C
o
Severe headache
o
Sore throat
o
Profuse diarrhoea and vomiting (notable feature
of the current outbreak)
o
General malaise
o
Abnormal bleeding/ unexplained haemorrhage
·
Differential
diagnosis
o
Malaria, typhoid or other rare infectious
diseases
·
If
suspected
o
Isolate immediately with appropriate infection
control measures and obtain urgent advice from local microbiologist or ID physician.
§
Goggles, masks and gloves etc
§
All used medical equipment, paper towels etc
will need incineration and should be kept separate for appropriate disposal
o
Seek urgent
guidance from local microbiology/ infection specialist
§
Further
guidance from PHE imported Fever Service
·
24 hours
per day 0844 778990
§
Diagnosis is confirmed by Rare and imported
pathogens laboratory 0844 778990
o
Immediate medical treatment is required
·
Treatment
o
Supportive
§
Eg rehydration etc
§
If patients illicit an immune response they
often recover
§
Death is often rapid and usually from sepsis/
shock
o
If recover then in view of risk of sexual transmission
§
Must abstain from UPSI for 3 months
§
Condom use suggested as a minimum
