Guidelines for Evaluation of Ebola Virus Disease

The Ebola is a global public health emergency. This emergency requires a strong and immediate coordinated international response to stop it, the current Ebola outbreak in West Africa in Guinea, Liberia, and Sierra Leone have been hit hardest by the current Ebola outbreak. Ebola’s blowup began in March. More than 1700 people have been infected, and at least 932 have died till date. Affected Countries do not have the capacity to manage an outbreak of Ebola.

The WHO's Public Health Emergency of International Concern (PHEIC) declaration on Ebola came after the first meeting of the International Health Regulations Emergency Committee on Ebola Viral Disease, held August 6 and 7 in Geneva.

The committee was unanimous in their conclusion that the Ebola outbreak meets the PHEIC criteria, defined in the International Health Regulations as "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response. The PHEIC declaration "alerts the world to the need for high vigilance for possible cases of Ebola virus disease, but by no means that all countries, or even many countries, will see Ebola cases. Poor health infrastructures in affected countries are fueling the outbreak. We have to basically stop the chain of transmission.

Probable or suspect cases of Ebola should be isolated until they have 2 blood tests at least 48 hours apart that are negative, .People with Ebola should be in treatment and kept in isolation for 30 days, the committee recommends. Contacts of infected people should be monitored for 21 days, and during that period, they should not travel. Contacts are people who would have been exposed to the virus in unprotected conditions.

Guidelines to Evaluation of patient of Having Ebola Virus Disease

Ebola virus is typically first spread to humans after contact with infected wildlife and is then spread person-to-person through direct contact with bodily fluids such as, but not limited to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8–10 days (ranges from 2–21 days). Patients can transmit the virus while febrile and through later stages of disease, as well as postmortem, when persons touch the body during funeral preparations.

Onset of Ebola

Sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea. Patients with severe forms of the disease may develop hemorrhagic symptoms and multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death. The fatality rate can vary from 40-90%.

Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) Epidemiologic risk factors within the past 3 weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active; or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries.

CDC recommends testing for all persons with onset of fever within 21 days of having a high-risk exposure. A high-risk exposure includes any of the following:

Per cutaneous or mucous membrane exposure or direct skin contact with body fluids of a person with a confirmed or suspected case of EVD without appropriate personal protective equipment (PPE), laboratory processing of body fluids of suspected or confirmed EVD cases without appropriate PPE or standard biosafety precautions, or participation in funeral rites or other direct exposure to human remains in the geographic area where the outbreak is occurring without appropriate PPE.

For persons with a high-risk exposure but without a fever, testing is recommended only if there are other compatible clinical symptoms present and blood work findings are abnormal or unknown.

Testing is recommended for persons with a low-risk exposure who develop fever with other symptoms and have unknown or abnormal blood work findings. Persons with a low-risk exposure and with fever and abnormal blood work findings in absence of other symptoms are also recommended for testing. Asymptomatic persons with high- or low-risk exposures should be monitored daily for fever and symptoms for 21 days from the last known exposure and evaluated medically at the first indication of illness.

Recommended Infection Control Measure

Patient placement: Patients should be placed in a single patient room (containing a private bathroom) with the door closed.

Healthcare provider protection: Healthcare providers should wear: gloves, gown (fluid resistant or impermeable), shoe covers, eye protection (goggles or face shield), and a facemask. Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.

Aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 filtering face piece respirator or higher) and the procedure should be performed in an airborne isolation room.

Environmental infection control: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is paramount, as blood, sweat, emesis, feces and other body secretions represent potentially infectious materials. Appropriate disinfectants for Ebola virus and other filoviruses include 10% sodium hypochlorite (bleach) solution, or hospital-grade quaternary ammonium or phenol products. Healthcare providers performing environmental cleaning and disinfection should wear recommended PPE (described above) and consider use of additional barriers (e.g., shoe and leg coverings) if needed. Face protection (face shield or facemask with goggles) should be worn when performing tasks such as liquid waste disposal that can generate splashes. Follow standard procedures, per hospital policy and manufacturers’ instructions, for cleaning and/or disinfection of environmental surfaces, equipment, textiles, laundry, food utensils and dishware.


More by :  Prof. Dr. Chandrashekhar Mule

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