Ebola
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Ebola Virus Disease (EVD) is a deadly disease in people and non-human primates. The viruses that cause EVD are located mainly in sub-Saharan Africa. People can get EVD through direct contact with an infected animal (bat or nonhuman primate) or a sick or dead person infected with Ebola virus. Symptoms appear from 2 to 21 days after contact with the virus, with an average of 8 to 10 days.
Case Definition:
Suspected case: Illness with onset of fever and no response to treatment of usual causes of fever in the area, and at least one of the following signs: bloody diarrhoea, bleeding from gums, bleeding into skin (purpura), bleeding into eyes and urine.
Confirmed case: A suspected case with laboratory confirmation (positive IgM antibody, positive PCR or viral isolation), or epidemiologic link to confirmed cases or outbreak.
Note: During an outbreak, case definitions are likely to be adapted to new clinical presentation(s) or different modes of transmission related to the local event. In outbreak setting, the following standard case definitions apply.
Suspected case: Any person, alive or dead, suffering or having suffered from a sudden onset of high fever and having had contact with: a suspected, probable or confirmed Ebola case; a dead or sick animal
OR
- Any person with sudden onset of high fever and at least three of the following symptoms: headaches - lethargy - anorexia / loss of appetite - aching muscles or joints - stomach pain - difficulty swallowing - vomiting - difficulty breathing - diarrhoea - hiccups;
OR
- Any person with inexplicable bleeding; OR
- Any sudden, inexplicable death; OR
- A person (alive or dead) suffering or having suffered from a sudden onset of high fever and having had contact with a dead or sick animal.
Clinical Diagnostic Criteria
A combination of symptoms suggestive of EVD AND a possible exposure to EVD within 21 days before the onset of symptoms is suggestive of Ebola.
Symptoms
- Fever
- Aches and pains, such as severe headache, muscle and joint pain, and abdominal (stomach) pain
- Weakness and fatigue
- Gastrointestinal symptoms including diarrhea and vomiting
- Abdominal (stomach) pain
- Unexplained hemorrhaging, bleeding or bruising
- Other symptoms may include red eyes, skin rash, and hiccups (late stage)
An exposure may include contact with:
- Blood or body fluids from a person sick with or who died from EVD
- Objects contaminated with blood or body fluids of a person sick with or who died from EVD
- Infected fruit bats and non-human primates (apes or monkeys) or semen from a man who has recovered from EVD.
Laboratory Investigations
Ebola virus can be detected in blood after onset of symptoms. It may take up to three days after symptoms start for the virus to reach detectable levels. Investigations includes:
- Blood for RT-PCR
- Antigen detection or IgM (ELISA)
Note: Do not take specimen before wearing appropriate PPE and ensuring the patient is in an Isolation Ward/ Centre
Pharmacological Treatment
A: paracetamol (PO/IV) 15mg/kg 8 hourly for 3 days
B: Give oxygen and manage hypoglycaemia if present
Fluid and electrolyte balance:
A: compound sodium lactate OR NS intravenously if cannot take fluids orally
B: Give Oxygen therapy to maintain oxygen status.
A: compound sodium lactate (Ringers Lactate), NS intravenously if cannot take fluids orally. Provide IV fluids and electrolytes (body salts) through infusion into the vein (intravenously)
A: Manage hypoglycaemia with 5% DNS or 25% Dextrose Solution if hypoglycaemia is shown by RBG testing
A: Using medication to support blood pressure, reduce vomiting and diarrhea and to manage fever and pain.
A: Treating other infections or any complicating infection and co-morbid condition
A: Psychological support is given to patient and family
C: Refer for provision of mechanical ventilation, renal dialysis, and anti-seizure therapy may be required.
Prevention
- Isolate person with signs of EVD and has had a possible exposure from other people.
- Notify the public health authorities.
- Blood samples from the patient should be collected and tested to confirm infection.
- Prompt identification of cases, contact tracing, and monitoring of high-risk individuals are essential to stopping Ebola virus from spreading.
- Early recognition of EVD is critical for infection control. However, because early symptoms are not specific to EVD, it can be hard to distinguish it from other illnesses, including malaria, leptospirosis, influenza (flu), yellow fever, dengue and other viruses spread by insects, or viral or bacterial infections of the intestines, like typhoid fever.
- EVD should be considered when clinical illness is combined with an epidemiologic risk factor, like direct contact with a suspected or confirmed case or travel to an Ebola-affected area.
- Once a case of EVD is identified, everyone who has come in direct contact with the sick patient is traced
- Contacts are watched for signs of illness for 21 days from the last day they came in contact with the Ebola patient. If the contact develops a fever or other EVD symptoms, they are immediately isolated, tested, and provided care.