Ebola virus disease
Revisión del 20:08 12 dic 2014 de Rossdonaldson1 (discusión | contribs.)
Background
- An RNA based virus from the Filovirus Family with 5 species mainly originating from Africa.
- Outbreaks in Gabon, Africa occured in 1996 and in July, 2014[1]
- Viral hemorrhagic fever
- Unknown reservoir with most likely being bats
2014 Outbreak Country Details[2]
- Widespread Transmission
- Guinea
- Liberia
- Sierra Leone
- Localized Transmission^
- United States
- Mali
- Previously Affected*
- Nigeria
- Senegal
- Spain
^Persons traveling from these countries should NOT be considered to be at risk for exposure to Ebola.
2014 Domestic Outbreak Details
- September 20
- Index case arrives in Dallas from Liberia
- September 25 & 28
- Index case visits hospital
- September 30
- first U.S. diagnosis of Ebola (index patient)
- October 8
- Index patient dies
- CDC implements enhanced entry screening at five U.S. airports
- October 10
- A healthcare worker who cared for index patient tests positive
- October 14
- A second healthcare worker tests positive for Ebola
- CDC establishes a dedicated response team for confirmed cases
Communicable Transmission
- Via blood and body fluids (urine, saliva, semen, feces, vomit) in contact with mucous membranes or via instruments such as needles[3]
Clinical Features[4]
- 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%)[5]
- 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%)
Differential Diagnosis
Fever in traveler
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Workup
- For travelers returning from countries with active Ebola follow the CDC Algorithm for Evaluation of the Returned Traveler
Persons under Investigation (PUI)
- 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
Management[6]
Transmission Precautions
- Isolate the patient
- single patient room (with private bathroom), door closed
- Wear appropriate PPE
- Enhanced standard, contact, and droplet isolation precautions[7]
- 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
Contact Public Health
- Immediately to the PUIs to local health authorities or CDD
- Los Angeles repots to Acute Communicable Disease Control Program (ACDC) at 213-240-7941 (nights/weekends: 213-974-1234)
- Special diagnostic testing requires consultation
Clinical Care
- 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
Disposition
Admit, isolation, possible ICU for serologic results and clinical observation/supportive care.
See Also
External Links
- CDC Main Site: http://www.cdc.gov/vhf/ebola/index.html
- PPE video: http://www.medscape.com/viewarticle/833907?src=ppc_google_acq_bola_vid
Sources
- ↑ Ebola Virus Disease, West Africa http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4233-ebola-virus-disease-west-africa-25-july-2014.html.
- ↑ CDC Website, accessed 12/10/2014
- ↑ 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