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Ebola virus disease

Information for Health Professionals and Laboratories

Last updated November 21, 2022

Important Update

  • On January 11, 2023, the World Health Organization (WHO) declared the 2022 Uganda Ebola outbreak over, and the U.S. Centers for Disease Control and Prevention (CDC) discontinued monitoring of travelers returning from Uganda.

  • A total of 142 cases including 55 deaths were reported from nine districts in Uganda during September-November 2022. The outbreak was declared over after 42 days (twice the incubation period for Ebola infection) have passed since the last case was reported.

Information for Healthcare Providers

Ebola virus disease (EVD) is a severe, often fatal infectious disease affecting humans and non-human primates. The genus Ebolavirus is composed of six species, four of which are known to cause disease in humans (Zaire, Sudan, Tai Forest, Bundibugyo).

Ebola viruses enter the body through mucous membranes, breaks in the skin, or parenterally. The incubation period for EVD is 2 to 21 days (usually 8 to 10 days). Initial signs and symptoms of EVD are nonspecific and can include fever, chills, myalgias, and malaise. Gastrointestinal 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.

Vaccines and Therapeutics

There are currently two U.S. Food and Drug Administration (FDA)-approved antibody treatments for EVD caused by Zaire ebolavirus, but none for EVD caused by Sudan ebolavirus. The Ebola vaccine licensed in the United States (ERVEBO,® Ebola Zaire Vaccine, Live, also known as V920, rVSVΔG-ZEBOVGP or rVSV-ZEBOV) is indicated for the prevention of EVD due to Zaire ebolavirus, and is not expected to protect against Sudan ebolavirus or other viruses in the Ebolavirus genus.

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

Screening and Diagnosis

While the risk of importation of Ebola virus into California is very low, many other infectious diseases can be introduced by returning California residents and global travelers. The California Department of Public Health (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 EVD.

If clinically stable, patients with a history of international travel and 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

  • Symptoms of EVD are similar to other illnesses associated with international travel, including malaria, yellow fever, and typhoid fever. Thus, it is essential that healthcare providers routinely ask patients with acute and possibly infectious illness about recent, international travel.

  • If there is suspicion of EVD in a patient, healthcare providers should immediately contact the local health department (24/7).

  • Strict infection control practices must be followed for suspected EVD patients, and appropriate personal protective equipment (PDF) should be used.

  • The Ebola vaccine licensed in the United States (ERVEBO®) is indicated for the prevention of EVD due to Zaire ebolavirus and is not expected to protect against Sudan ebolavirus or other viruses in the Ebolavirus genus.

Reporting and Infection Control

Clinicians should consider EVD in their differential diagnosis for any patient who has signs and symptoms consistent with EVD (such as fever, severe headache, muscle pain, weakness, fatigue, vomiting, diarrhea, stomach pain, and unexplained bleeding) and has traveled to an EVD affected area within the 21 days before the onset of symptoms. 

If there is suspicion of EVD in a patient based on travel history and clinical presentation, healthcare providers should immediately isolate the patient and notify their local health department (LHD) and implement the following EVD-specific infection prevention and control precautions: hospital-bed

  • 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) (PDF).

  • Minimize procedures that could create splashes with blood and body fluid or increase environmental contamination with infectious material or create aerosols.

Information for Laboratories

Ebola virus testing is available at CDPH, select public health laboratories in California, and by the U.S. Centers for Disease Control and Prevention (CDC). Any Ebola testing performed in California requires approval from CDPH and the CDC. All suspected Ebola virus specimens must be packaged and transported as Category A, UN 2814. To prepare for Ebola virus specimen handling, packaging and shipping, please contact your local public health laboratory for guidance and assistance. If a healthcare provider requests testing, laboratorians should immediately notify the local health department (LHD).  

Laboratory and Biosafety Considerations 

  • Presumptive testing for EVD due to Sudan ebolavirus or Zaire ebolavirus can be performed using the BioFire FilmArray NGDS Warrior Panel (it can also detect Tai Forest, Bundibugyo, and Reston viruses). This test is not available at commercial or clinical laboratories. There are currently four laboratories in California approved by the CDC to use the BioFire Warrior Panel: Los Angeles County Public Health Laboratory (PHL), Santa Clara County PHL, CDPH Viral and Rickettsial Disease Laboratory, and Cedars-Sinai Medical Center Laboratory, a Regional Treatment Center for Ebola. Confirmatory testing for presumptive positive samples must be performed at the CDC. blood-samples

  • The decision to test for EVD must be made in conjunction with the patient's clinical care team, the LHD, CDPH, and CDC's Viral Special Pathogens Branch (VSPB). 

  • All personnel handling specimens from patients with suspected EVD should adhere to recommended infection control practices to prevent infection and transmission. 

  • As a component of the Occupational Safety and Health Administration's (OSHA's) Bloodborne Pathogens Standard, laboratories handling blood and body fluids must have an Exposure Control Plan (PDF) in place to eliminate or minimize employees' risk of exposure to pathogens. 

  • Laboratories should conduct extensive risk assessments to identify and mitigate hazards associated with handling specimens from patients with suspected EVD. The proper PPE needs to be identified, available, and staff trained to properly don and doff PPE. Staff need to be specially trained, have passed competency testing, and attended drills to safely receive, handle, and process these specimens. 

  • A laboratory should have dedicated space, equipment and supplies for handling and testing specimens from ill patients with suspected EVD for differential diagnosis of other illnesses and should also have plans for minimizing specimen manipulation. Because EVD and other viral hemorrhagic fevers resemble many other infectious diseases in the early stages, in-room disposable point-of-care screening tests for other travel and non-travel related illnesses may be useful for differential diagnosis.

  • All waste from suspected EVD patients should be handled as Category A until EVD is ruled out. A waste management plan needs to be in place for lab reagents and Category A waste, including PPE and specimen material. 

  • If a facility does not have the appropriate risk mitigation capabilities for testing specimens from suspected EVD patients, then the specimens should be forwarded to another facility that does. 

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