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Ebola Virus Disease 2014 Outbreak

The following is from a presentation by Dr. Josée Pilon, M.D., A/National Medical Advisor, Public Service Occupational Health Program, Health Canada, at the Canada School of Public Service, November 6, 2014. The information in this presentation is current as of November 4, 2014.

Outline

What is Ebola Virus Disease?

  • Severe viral disease that causes hemorrhagic fever in humans and animals.
    • Discovered in 1976, usually found in remote villages in Central Africa, near tropical rainforests.
    • Current outbreak involves major urban as well as rural areas.
    • Case fatality rate in West Africa approximately 70% (New England Journal of Medicine October 16, 2014).
    • Ebola infection can only be confirmed through laboratory testing.
  • Incubation period: 2-21 days (average 8-10 days).

Signs and Symptoms

  • Initial symptoms:
    • Fever and chills
    • Muscle pain and weakness
    • Headache
    • Sore throat
  • Additional symptoms:
    • Nausea, vomiting, diarrhea, rash
    • Impaired kidney and liver function
  • Internal and external bleeding can occur in certain cases
    • Hemorrhagic symptoms (oozing from the gums, blood in the stools) occur in about 50% to 60% of cases, often in the later stages of disease.

How is Ebola Spread?

  • Through contact with:
    • Blood, body fluids or tissues of infected persons;
    • Objects contaminated with blood or body fluids of an infected person; and
    • Infected animals (chimpanzees, gorillas, monkeys, forest antelope, pigs, porcupines, duikers and fruit bats).
  • Airborne spread has not been documented among humans.
  • Infected persons are contagious only once they begin to show symptoms.
    • They are not contagious during the incubation period.
  • Ebola is not spread through casual contact.

Current Situation

(as of October 31, 2014)
Area Number of cases See table 1 note [1] Number of deaths

Note: Medically evacuated cases are counted at the country of origin.

Return to table 1 note [1] reference Source: World Health Organization, Situation Reports: Ebola Response Roadmap. Probable, suspected and confirmed cases.

West Africa

(Guinea, Liberia, Sierra Leone)

 13,540 4,941
USA (Dallas) 4 1

Spain (Madrid)

 1 0
Mali 1 1
Nigeria 20 8
Senegal 1 0
Democratic Republic of Congo (Unrelated to outbreak in West Africa) 68 49

Countries Affected by Current Outbreak

(as of November 4, 2014)

  • Current Affected Countries: (widespread and intense transmission)
    • Guinea
    • Liberia
    • Sierra Leone
    • Democratic Republic of the Congo  (separate outbreak)
  • Countries with Initial Case(s), or with Localized Transmission:
    • United States, Spain and Mali
  • Countries where Ebola was present but are now declared Ebola free:
    • Nigeria
    • Senegal

"This is a spectacular success story that shows that Ebola can be contained." - World Health Organization, October 20, 2014

Ebola outbreak response: maps

Risk of Ebola

  • The risk to Canadians remains very low. 
  • The risk to employees is very low.
  • This includes employees in overseas missions and at Points of Entry.
    • The Ebola virus does not spread easily from person to person. It is spread through contact with infected body fluids of persons showing signs of illness or those who have died.
    • As long as appropriate precautions are taken, there is a very low risk of contracting Ebola.
    • Individuals who have close unprotected (i.e. without personal protective equipment) contact with infected humans and animals are most at risk. These include:
      • Hospital staff and health care workers
      • Laboratory or quarantine facility workers
      • Family members caring for patients
      • Individuals handling deceased infected bodies
      • Individuals handling infected wild animal carcasses

Protecting Yourself at Work

  • Know the symptoms of Ebola.
  • Stay informed on the current outbreak.
  • Follow your Health and Safety procedures, including recommendations for the safe and effective use of personal protective measures.
  • General Safety Measures:
    • Personal hygiene, such as frequent hand washing.
    • Avoid touching your eyes, nose and mouth, and avoid close contact with people who are sick.
    • Regular cleaning and disinfection of commonly used and shared surfaces.

How to Protect Yourself

  • Avoid direct contact with blood, saliva, vomit, urine and other body fluids.
    • Avoid contact with any objects soiled with blood or body fluids.
      Precautionary principle – applies to any unknown illness of infectious origin
  • Practice regular hand hygiene.
  • Avoid touching your eyes, nose and mouth.
  • Avoid close contact with people who are sick.
  • Avoid contact with the deceased.
  • Avoid contact with animals and with raw animal meat/bushmeat.
    • E.g. Chimpanzees, gorillas, monkeys, forest antelope, pigs, porcupines, duikers and fruit bats may be carriers. Fruit bats are believed to be the likely natural reservoir.

Guidance documents produced by the Public Health Agency of Canada

Approach to a Person of Unknown Health Status Appearing Sick (non-healthcare setting)

  • Individuals at risk of Ebola include those with the following history/risk factors:
    • Travel from countries where the outbreak is occurring.
    • Contact with a person or deceased infected with Ebola.
    • Return from health care facility where Ebola is being treated.
  • At minimum, the recommended measures include:
    • Isolation/separation of the sick individual to minimize contact.
    • Hand hygiene – both the individual and the employee.
    • Referral to local health facilities for prompt medical assessment.
    • If close interaction required, the use of protective measures according to risk assessment, based on role and activity.
    • Cleaning and disinfecting procedures:
      • Securing the area until confirmation of diagnosis.
      • Further infection protection and control measures from Occupational Health and Safety Unit and/or local health authorities on decontamination and sanitization if confirmed Ebola.
      • Guidance document on Waste management under development.

Infographic – Have YOU travelled from Africa recently?

Role of Personal Protective Equipment

  • Part of Infection Prevention Control Measures.
  • Barrier between the worker and the infectious agents. 
  • Choice of equipment depends on the activity conducted and the barrier required for the mode of transmission.
  • Requires training for proper use, e.g. careful donning and removal of gloves, gowns, face shield etc., in accordance to procedures issued by Occupational Health and Safety unit.

Treatment

  • No specific licensed treatment or vaccine.
  • Patients are treated for their symptoms and clinical presentation.
  • Strict isolation to prevent the infection from spreading
  • Intensive care unit
  • Maintenance of core body function, including fluid levels, oxygen status and blood pressure
  • Professional Resources, available on the Public Health Agency of Canada's Health Professionals web page.  

Innovative Therapy

  • Experimental therapies – their benefits are not proven yet, with insufficient data on clinical efficacy and patient safety. Clinical trial efforts are underway.
  • Immunization:
    • Vaccines such as the rVSV-EBOV vaccine. (Discovered at the Public Health Agency of Canada)
  • Treatment:
    • Monoclonal antibodies administration (mAbs) (Canadian involvement for two of the three elements of ZMapp)
    • Plasma therapy from recovered patients
    • Small inhibitory RNA molecules (Tekmira)
    • Hyper-immune globulin
    • Antiviral

Key messages

  • Ebola – not airborne.
  • Transmission is from direct contact with body fluids from an infected and sick individual.
    • There is no transmission during the incubation period.
  • Regular hand hygiene is an essential component of infection control.
  • Virus is easily destroyed by disinfectant such as bleach.
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