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.