Ebola
Dr Nick Gent
current situation
• On 23 March 2014, WHO confirmed an outbreak of Ebola virus
disease (EVD) in South-eastern Guinea, the first time an outbreak
has been identified in this part of Africa - now the largest known
outbreak of this disease.
• As of 21st November (reported by WHO -data as on 16th
November):
• 8 affected countries (Guinea, Liberia, Mali, Nigeria, Senegal, Sierra
Leone, Spain, and the United States of America)
• 15,145 confirmed, probable, and suspected cases of EVD reported –
5,420 deaths.
• WHO Ebola Response Roadmap structure: country reports fall into
two categories:
• those with widespread and intense transmission (Guinea, Liberia, and
Sierra Leone)
• those with an initial case or cases, and/or with localized transmission
(Nigeria, Senegal, Mali, Spain, and the United States of America)
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symptoms of Ebola virus disease
• The incubation period, that is, the time interval from infection
with the virus to onset of symptoms is 2 to 21 days. Humans
are not infectious until they develop symptoms.
• It can be difficult to distinguish EVD from other infectious
diseases such as malaria, typhoid fever and meningitis from
clinical symptoms alone.
• First symptoms are the sudden onset of fever, fatigue, muscle
pain, headache and sore throat. This is followed by vomiting,
diarrhoea, rash, symptoms of impaired kidney and liver
function, and in some cases, both internal and external
bleeding (e.g. oozing from the gums, blood in the stools).
• Laboratory findings include low white blood cell and platelet
counts and elevated liver enzymes.
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transmission of Ebola
• Principal mode of transmission:
• Initially: direct contact with infected animals
• Subsequently: person-to-person spread by contact with bodily
fluids (including blood, diarrhoea, vomit and urine)
• There is no risk of transmission during the incubation period and
only low risk of transmission in the early phase of symptomatic
patients
• Airborne transmission has not been documented during previous
EVD outbreaks
• In a household study, secondary transmission took place only if
direct physical contact occurred - No transmission was reported
without this direct contact
• EVD does not survive well in the environment and is readily
destroyed by washing with soap and water and common
disinfectants, including alcohol gels
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Ebola infectivity
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Ebola infectivity
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•
Ebola virus is spread among people through close and direct physical contact with infected body
fluids
•
People infected with Ebola can only spread the virus to other people once they have developed
symptoms. In the early stages these include fever, headache, joint and muscle pain, sore throat,
and intense muscle weakness
•
Ebola virus is not spread through routine, social contact (such as shaking hands or sitting next to
someone) with people who do not have visible symptoms
•
When people have no or very mild symptoms (just a low fever) the level of virus is very low and
unlikely to pose a risk to others
•
Once people are unwell, then all body fluids (such as blood, urine, faeces, vomit, saliva and
semen) are infectious, with blood, faeces and vomit being the most infectious
•
When someone reaches the point at which they are most infectious, they are unlikely to be in any
condition to move or interact socially. The most risk is to people involved in their care and not the
general public
•
Skin is almost certainly contaminated in late stage disease because of the impossibility of
maintaining good hygiene, but other people are not at risk unless they are directly involved in
caring for a person with advanced disease and without wearing personal protective equipment.
•
Semen can remain infectious for up to three months after recovery
Ebola UKMPA Conference
prevention and control
Reducing the risk of human-to-human transmission
•
Ensuring those travelling to and working within affected countries know what to
do if they develop symptoms
•
Case identification: ensuring suspect cases receive immediate medical attention
and are isolated
•
Use of PPE, hand hygiene, case management and maintaining a clean
environment
•
Conducting prompt and safe burials of the dead
Surveillance and contact tracing
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•
Identifying people who may have had hazardous contact with someone infected
with Ebola
•
Monitoring the health of contacts for 21 days
•
Separating the healthy from the sick and emphasising the importance of good
hygiene.
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Preparing the health system response
Raising awareness & knowledge of health care providers
• Sensitise staff working at “points of entry”, in healthcare settings or
involved in first response - early and advanced symptoms of viral
haemorrhagic fever
• Emphasise systematic questioning and recording of travel history of
those with relevant symptoms and consider the possibility of EVD in
person coming back from affected areas
Putting procedures in place to deal with suspected cases
• Follow the standard algorithms and diagnostic procedures for EVD
and for common differential diagnoses at an early stage
Diagnosing and managing confirmed cases
• Follow the protocol for notification to Public Health England (Health
Protection Team) at an early stage if an EVD case is suspected
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screening and monitoring
Enhanced screening
• Screening and monitoring UK-bound air passengers, identified by
the Border Force, coming on to the main routes from Liberia, Sierra
Leone and Guinea
• Heathrow, Gatwick and St Pancras (Eurostar), Manchester and
Birmingham
• Passenger ships (cruise ships) where risk is identified due to
passenger mix / movements
Assessment and monitoring
• Passengers identified as high risk of Ebola with a raised
temperature and/or other symptoms will undergo clinical
assessment and, if necessary, transfer to hospital
• Those identified as at an increased risk, but without symptoms will
be given advice and contact details. PHE will ensure that there is
daily contact with individuals at higher risk of developing disease
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diagnosing and managing potential VHFs
• Patients are considered for assessment if
• Fever of ≥37.5C OR a history of fever in the past 24 hours
AND
• have recently visited any of the affected areas within the previous 21
days.
OR
• have cared for / come into contact with body fluids of / handled
clinical specimens (blood, urine, faeces, tissues, laboratory cultures)
from an individual or laboratory animal known or strongly suspected
to have VHF
• Even if meet diagnostic criteria VHF unlikely and will be managed at
a local hospital
• Cases on board ship to go through normal MCA agreed process
• Local infectious disease specialist will discuss with imported fever
service
• Malaria screen essential as this is the most likely serious diagnosis
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role of PHE
1. Management of suspected and confirmed cases
2. Management of contacts
3. Monitoring the health of returning travellers
4. Responding to enquiries from partner agencies and the community
5. Maintaining database of cases, contacts and enquiries
6. Providing guidance and a point of contact for ad hoc professional enquiries
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Ebola virus disease: clinical management and
infection control guidance - GOV.UK
Viral haemorrhagic fever: ACDP algorithm and guidance on management of
patients - Publications - GOV.UK
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/3
77142/Algorithm_v5.pdf
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/3
77223/Ebola_infection_prevention_and_control_guidance_for_primary_care.pd
f
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/3
77163/Ebola_summary_guidance_for_acute_trust_staff.pdf
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key messages
• Overall risk of Ebola in the UK remains low
• UK has robust systems to deal with infectious diseases
• Awareness has been raised at all levels of the Health Care System
and with relevant Agency dealing with port of entry to the country
(Border Agency and Port Health)
• Enhanced screening has been implemented at main airports AND
other points of entrance (St. Pancreas Eurostar station) in the UK
• Ebola can only be transmitted from an infected individual to another
when there is direct contact with the body fluids (blood, urine, vomit
and diarrhoea) with the unprotected mucosa or broken skin (i.e.
abrasions, wounds) of another person
• No viable virus will have travelled as an environmental contaminant
with a ship from West Africa
• Probability of a case arriving by ship is very low – and this case will
only be infectious if symptomatic
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Questions?
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