Ebola virus disease (EVD)

see also:

• viruses
• WH Ebola plan Dec 2014
• WHO - Ebola
• Aust. Govt. - Ebola information
• Aust. Govt. case definitions Ebola
• Vic. Govt Ebola Response Plan 2014 (pdf)
  • if suspect a case (see below for criteria):
    • under law must notify the Department (DH) immediately by calling 1300 651 160 in order to enable an assessment by the Chief Health Officer (CHO) or delegate and in order to trigger other immediate public health actions.
    • isolate the patient in a single room immediately (negative pressure room if possible) and minimise unnecessary staff and family contact (ie. NO visitors)
    • ensure standard, contact and droplet precautions are taken by all staff (and by parent(s) of a child case if it is essential for them to remain with the patient) who are providing care in the same room, which means PPE composed of a minimum :
      • a fluid-resistant submicron single use face mask AND
      • eye goggles AND
      • a fluid-impermeable gown AND
      • gloves
      • check hospital policy as many are advocating full PPE protection with multiple gloves, face mask, full head to ankle PPE suit, etc.
    • AVOID:
      • taking a throat swab or undertaking any aerosol generating procedure or venepuncture unless immediately essential for clinical care
      • arranging ambulance transfer - DH will liaise with this
        • designated quarantine hospital is RMH (or RCH)
    • READ the above PLAN (pdf) carefully
• Western Health's Ebola Plan (pdf)

• the Ebola viruses are part of the family Filoviridae which also includes Marburg virus.
• the likely natural host are fruit bats of the Pteropodidae family.
• first emerged in the Democratic Republic of Congo and the Sudan in 1976.
• it mainly occurs in rainforest areas of central Africa including Sudan, Congo, Uganda, Ivory Coast, Sierra Leone, Liberia, Guinea.
• EVD is a severe, highly infectious disease of humans and primates which is fatal in ~90% of cases
• outbreaks are usually contained within a few months, but social stigma and fear means many infected individuals do not seek medical help, if it is available, thereby spreading infection

• there have been ~25 outbreaks in Africa over the past 50 yrs
• outbreaks tend to be more likely in countries that had been affected by war
• most outbreaks are due to the EBOV (Zaire) strain
  • there is a vaccine for this strain - developed during the 2013-2016 outbreak
  • the largest Ebola outbreak was the 2013–2016 West African epidemic, where almost 30,000 cases were recorded, and more than 10,000 people died
  • another outbreak occurred in 2018–2020 in Central Africa, where almost 3,500 cases were reported
• the Bundibugyo strain has caused only three recent outbreaks, in 2007 (131 cases), 2012 (38 cases) and May 2026
  • it has a quoted mortality of 25 to 50 per cent, and requires very close contact and exposure to blood and body fluids to be transmitted
  • there are no vaccines at present for this strain

• a suspected case of EVD is a case with clinical evidence AND epidemiological evidence

• a history of fever ≥38°C in the last 24 hours OR subjective history of fever in the last 24 hours
• WITH OR WITHOUT:
  • additional symptoms such as severe headache, muscle pain, vomiting, diarrhoea, abdominal pain, unexplained haemorrhage.

• within 21 days prior to onset of symptoms there was:
  • residence in or travel to an area where EVD transmission is active OR
  • one or more high risk exposures (see below) OR
  • one or more low risk exposures (see below)

• Sierra Leone
• Guinea
• Liberia
• Nigeria
• +/- Democratic Republic of Congo (DRC)

• percutaneous or mucous membrane exposure to blood or body fluid of an EVD patient
• direct skin contact with or exposure to blood or body fluids of an EVD patient without appropriate PPE
• processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
• direct contact with a dead body without appropriate PPE in a country where EVD transmission is active

• household contact with a confirmed case of EVD;
• persons who had direct contact with bats or primates in States with active EVD transmission;
• other close contact with a confirmed case of EVD in health care facilities or community settings.
  • close contact is defined as:
    • being within the same room of a patient with active vomiting or diarrhoea or coughing or the patient having an aerosol generating procedure, while not wearing appropriate personal protective equipment (i.e. as per standard, contact and droplet precautions);
    • having direct brief contact (e.g. shaking hands) with an EVD patient while not wearing appropriate personal protective equipment.

• being in the near vicinity of a case with possible contact with a shared surface without appropriate PPE.

• spread is via contact with secretions, blood or bodily fluids of infected wild animals, persons or corpses
• includes contact with heavily contaminated fomites, sexual transmission, needles, and handling of raw or undercooked infected meat
• burial ceremenonies are a known high risk activity for transmission
• no documented cases of aerosol transmission

• quarantine processes
• standard contact and droplet precautions using gowns, gloves, face shields and masks
• avoid high risk activities including sexual intercourse during infective period and eating wild animals
• avoid aerosol-generating procedures unless adequate airborne precautions including negative pressure room, P2 masks, gowns, gloves are used.
• in Victoria, suspected cases requiring ambulance transfer must have PRIOR notification to the Communicable Disease Prevention and Control Section of Department of Health on 1300 651 160 and ambulance personnel and receiving facilities must be made aware of the possible diagnosis

• infected individuals are an infectious risk from onset of symptoms until at least 7 weeks after clinical recovery

• viral haemorrhagic fever
• incubation period with current strain is 4-6 days (but may be up 21 days)
• sudden onset fever, muscle & joint aches
• usually progresses rapidly to vomiting, diarrhoea, and sometimes haemorrhage from eyes, ears, mouth, and rectum with purpura and death

• viral PCR or serology on blood samples - these require significant precautions see documentation ¹⁾
  • in Victoria, must notify VIDRL first on (03) 8344 5689

• supportive care
• infection control