Ebola disease

Information for Health Professionals
Overview

Ebola disease is a severe viral hemorrhagic fever affecting humans and non-human primates. There are four orthoebolaviruses that cause illness in people:

Ebola virus (species Orthoebolavirus zairense)
Sudan virus (species Orthoebolavirus sudanense)
Tai Forest virus (species Orthoebolavirus taiense)
Bundibugyo virus (species Orthoebolavirus bundibugyoense)

All four of the orthoebolaviruses enter the body through mucous membranes, breaks in the skin, or parenterally. The incubation period for Ebola disease is 2 to 21 days (usually 8 to 10 days). Initial "dry" signs and symptoms of Ebola disease are nonspecific and can include fever, chills, myalgias, and malaise. Gastrointestinal ("wet") symptoms, including watery diarrhea, vomiting, and abdominal pain, follow initial symptoms after about 5 days. Other symptoms, such as chest pain, confusion, and unexplained bleeding, may occur.

Screening

While the risk of importation of Ebola virus into California is very low, other infectious diseases can be introduced by returning California residents and global travelers. CDPH regularly receives reports of malaria, dengue, typhoid fever, hepatitis A, measles, enteric illnesses, and a variety of other illnesses among persons with a history of international travel. Thus, it is essential that healthcare providers in hospitals, emergency departments, and clinics routinely ask patients with acute and possibly infectious illness about recent, international travel (see CDC Screening Patients). This information is also critical to implementing appropriate infection control procedures in all settings, and for all infectious diseases, including Ebola disease.

If clinically stable, patients who have recently traveled to a country experiencing an Ebola outbreak and have symptoms of an acute communicable disease should be encouraged to use telehealth options for initial screening and evaluation rather than going directly to their healthcare provider or emergency room.

Key Points

It is essential that healthcare providers routinely ask patients with acute and possibly infectious illness about recent, international travel.
Symptoms of Ebola disease are similar to other illnesses associated with international travel, including malaria, yellow fever, and typhoid fever. Consider other infectious diseases as cause of symptoms, as well as the possibility of co-infection.
If there is suspicion of Ebola disease in a patient, healthcare providers should immediately contact the local health department (24/7).
Strict infection control practices must be followed for suspected Ebola disease patients, and appropriate PPE should be used.
FDA-approved therapeutics (Inmazeb™ and Ebanga™) and a vaccine (ERVEBO®) are available for the treatment and prevention of Ebola disease due to Orthoebolavirus zairense only.

Reporting and Infection Control

If there is suspicion of Ebola disease in a patient based on clinical presentation, travel history, and epidemiologic risk factors, healthcare providers should immediately isolate the patient and inform their hospital's infection control program and their local health department.

Clinicians should include Ebola disease in the differential diagnosis for an ill person who has been to an area with an active Ebola disease outbreak in the past 21 days, and who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), and who has reported one or more of the following epidemiologically compatible risk factors within the 21 days before symptom onset:

Had direct contact with a symptomatic person with suspected or confirmed Ebola disease (alive or dead), or with any objects contaminated by their body fluids
Experienced a breach in infection prevention and control precautions that resulted in the potential for contact with body fluids of a patient with suspected or confirmed Ebola disease
Participated in any of the following activities while in an area with an active Ebola disease outbreak:

Had contact with someone who was sick or died or with any objects contaminated by their body fluids
Attended or participated in funeral rituals, including preparing bodies for funeral or burial
Visited or worked in a healthcare facility or laboratory
Had contact with cave-dwelling bats or non-human primates
Worked or spent time in a mine or cave

Identify

Ask patients with acute and possibly infectious illness about recent, international travel.

Consider Ebola disease in a patient with appropriate clinical presentation, travel history, and epidemiologic risk factors.

Isolate

If you identify a patient with potential Ebola disease, isolate the patient in a private room.

Inform

Notify your hospital’s infection control program and your local health department.

Healthcare providers suspecting Ebola disease in a patient should implement the following Ebola disease-specific infection prevention and control precautions:

Immediately isolate the patient in a private room with an in-room bathroom or covered bedside commode.
Consider methods for performing detailed patient/family interviews in coordination with public health to rapidly clarify a patient's status with minimal contact between healthcare personnel and the patient, such as via telephone communication while healthcare personnel remain outside the isolation room.
Limit healthcare provider contact with the patient to providing essential patient care; any persons having contact with the patient should practice appropriate precautions and use appropriate personal protective equipment (PPE).
Minimize procedures that could create splashes with blood and body fluid or increase environmental contamination with infectious material or create aerosols.

Testing

If Ebola disease is suspected, the local health department will coordinate with CDPH and CDC to help the provider determine the likelihood of Ebola disease and whether Orthoebolavirus testing is indicated.
Orthoebolavirus testing is available at select public health labs in California.

CDPH and CDC must approve testing before specimens are collected. The CDPH Viral and Rickettsial Disease Laboratory (VRDL) will not test any unapproved suspect Ebola specimens. Contact your local public health department for pre-approval information.

For additional testing guidance, see VRDL Test Order Ebola Virus Detection – PCR

Treatment, Vaccines, and Therapeutics

The mainstay of treatment for Ebola disease involves supportive care to prevent intravascular volume depletion, avoiding complications of shock, and correcting electrolyte abnormalities.

Learn more about treatment options for Ebola disease

There are currently therapeutics and a vaccine only for Ebola disease caused by Ebola virus (Orthoebolavirus zairense):

Two U.S. Food and Drug Administration (FDA)-approved antibody treatments: Inmazeb™ and Ebanga™
FDA-approved vaccine (ERVEBO®) for use in qualifying persons 12 months of age and older as a single dose administration

Alerts and Updates