Ebola: Monitoring Personnel Returning From Africa

As of Nov. 16, 2014, there are 15,113 total cases in Africa (Guinea, Liberia and Sierra Leone) and of those, 5406 have died. Mali, Nigeria, Senegal, Spain and the US, there have been 32 total cases and 14 deaths. There has been an additional death in the US since that date.

Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees). Ebola is caused by infection with a virus of the family Filoviridae, genus Ebolavirus.

Ebola viruses are found in several African countries. Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa.

The natural reservoir host of Ebola virus remains unknown. However, on the basis of evidence and the nature of similar viruses, researchers believe that the virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in an animal host native to Africa.

The Centers for Disease Control (CDC) report that the 2014 EBOLA Ebola epidemic is the largest in history, affecting multiple countries in West Africa. CDC and partners are taking precautions to prevent the further spread of Ebola within the United States.

CDC is working with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international partners and has activated its Emergency Operations Center to help coordinate technical assistance and control activities with partners. CDC has also deployed teams of public health experts to West Africa and will continue to send experts to the affected countries.

Prevention

There is no FDA-approved vaccine available for Ebola.

If you travel to or are in an area affected by an Ebola outbreak, make sure to do the following:

• Practice careful hygiene. For example, wash your hands with soap and water or an alcohol-based hand sanitizer and avoid contact with blood and body fluids.

• Do not handle items that may have come in contact with an infected person’s blood or body fluids (such as clothes, bedding, needles, and medical equipment).

• Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.

• Avoid contact with bats and nonhuman primates or blood, fluids, and raw meat prepared from these animals.

• Avoid facilities in West Africa where Ebola patients are being treated. The U.S. embassy or consulate is often able to provide advice on facilities.

• After you return, monitor your health for 21 days and seek medical care immediately if you develop symptoms of Ebola. Healthcare workers who may be exposed to people with Ebola should follow these steps:

• Wear appropriate personal protective equipment (PPE).

• Practice proper infection control and sterilization measures. For more information, see Information for Healthcare Workers and Settings.

• Isolate patients with Ebola from other patients.

• Avoid direct, unprotected contact with the bodies of people who have died from Ebola.

• Notify health officials if you have had direct contact with the blood or body fluids, such as but not limited to feces, saliva, urine, vomit, and semen of a person who is sick with Ebola. The virus can enter the body through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth.

Today, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) added Mali to the list of Ebola-affected nations for which enhanced screening and monitoring measures will be taken.

Effective Nov. 17, people arriving in the United States whose travel began in Mali will be subject to the same enhanced entry screening, health and Ebola exposure assessment, and symptoms monitoring that are already employed for travelers from Liberia, Sierra Leone, and Guinea.

In addition, all travelers entering the United States from Mali will be subject to the 21-day monitoring and movement protocols now in effect for travelers from Liberia, Sierra Leone and Guinea, with twice daily temperature and symptom checks in coordination with state or local public health authorities.

Other Prevention Efforts

The CDC has other efforts in place to prevent Ebola. These resources include: (1) Interim Guidance for Managers and Workers Handling Untreated Sewage from Individuals with Ebola in the United States, (2) Communicating with West African Communities - New Lists of Available Materials, (3) How to Talk with Your Children about Ebola Factsheet, a two page PDF fact sheet.

How It's Transmitted

Scientists believe that the first patient becomes infected through contact with an infected animal, such as a fruit bat or primate (apes and monkeys), which is called a “spillover event.” Person-to-person transmission follows and can lead to large numbers of affected people.

When an infection occurs in humans, the virus can be spread to others through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola.

Ebola is not spread through the air, by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bush meat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitoes or other insects can transmit the Ebola virus. Only a few species of mammals (e.g., humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.

Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with infected blood or body fluids.

During outbreaks of Ebola, the disease can spread quickly within healthcare settings (such as a clinic or hospital). Exposure to Ebola can occur in healthcare settings where hospital staff are not wearing appropriate personal protective equipment.

Dedicated medical equipment (preferably disposable, when possible) should be used by healthcare personnel providing patient care. Proper cleaning and disposal of instruments, such as needles and syringes, also are important. If instruments are not disposable, they must be sterilized before being used again. Without adequate sterilization of instruments, virus transmission can continue and amplify an outbreak.

Once people recover from Ebola, they can no longer spread the virus to people in the community. Although Ebola virus has been detected in semen after patients have recovered, it is not known if the virus can be spread through sex (including oral sex). As a precaution, men who have recovered from Ebola are advised to abstain from sex (including oral sex) for three months. If abstinence is not possible, condoms may help prevent the spread of disease.

Signs and Symptoms

• Fever
• Severe headache
• Muscle pain
• Weakness
• Fatigue
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from two to 21 days after exposure to Ebola, but the average is eight to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

Best Practices for Procuring PPE for Ebola Response

On Oct. 20, 2014, CDC issued new guidance for personal protective equipment. HHS has been working closely with PPE manufacturers and distributors in order to maintain visibility on availability of PPE.

Since the issuance of the CDC guidance, there has been a sudden increase in demand for PPE. Across the U.S., availability for these products varies by product type and model, requested quantity, manufacturer, distributor, and geographic region.

It is important to note that CDC guidance recommends use of either a PAPR or an N95 respirator, both of which provide a high level of protection that will allow healthcare workers to safely manage patients with Ebola. Therefore, if one option is not available, the other could be used instead. Visit the NIOSH Respirator Trusted Source site to identify respirators meeting the requirements specified in the guidance here.

CDC recommends use of either a fluid-resistant or impermeable coverall or a fluid-resistant or impermeable gown. Therefore, if a coverall is not immediately available, a single-use, fluid-resistant or impermeable gown that extends to at least midcalf in combination with single-use, fluid-resistant or impermeable boot covers that extend to at least mid-calf can be worn.

HHS is working with distributors and manufacturers to understand various ways customers may be able to find supplies needed for training and use in evaluation and/or treatment of patients with suspected or confirmed cases of Ebola. The following options may assist hospitals in obtaining PPE.

• Work within Healthcare Coalitions, local hospitals, and state and local health departments to create plans for sharing available PPE in the event of a suspected or confirmed case of Ebola. A list of State Public Health Department phone numbers is available.

• Work with your distributor, Group Purchasing Organization (GPO), or Healthcare Coalition to discuss substitute brands, timelines, and terms of your contract to determine if viable alternative products are in stock that can substitute for your request.

• Contact manufacturers of product to note your interest in purchasing additional product. Manufacturers may not increase production of items unless they are sure of future orders. Reporting your interest to them may assist in their decision-making. There may still be a 6-10 week timeline before product is delivered due to production and shipment times.

• Consider non-traditional supply partners such as industrial distributors and retailers.

• While manufacturers report that they are increasing production of PPE products and distributors are identifying ways to provide requested quantities and meet delivery timelines, some products may be available but in lower quantities than requested or with a longer delivery time than requested.

• If your facility suspects or identifies a case of Ebola, contact your state health department to facilitate additional assistance. Treatment No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola. Symptoms of Ebola and complications are treated as they appear. The following basic interventions, when used early, can significantly improve the chances of survival:

• Providing intravenous fluids (IV) and balancing electrolytes (body salts)

• Maintaining oxygen status and blood pressure

• Treating other infections if they occur

Experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness.

Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola. Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.