Download Ebola Virus Disease - International Scientific Forum on Home Hygiene

Ebola Virus Disease: what you should know and
how to manage the risks
This leaflet has been put together to provide background information on Ebola Virus
Disease (EVD). This briefing material has been produced for those who work in
healthcare professions, the media, those with responsibility for giving guidance to the
public, and others who are looking for some background understanding of issues and
risks related to Ebola. It provides information on symptoms, transmission and how to
manage the risk of infection, with links to further information and tools.
Key facts
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Ebola Virus Disease (EVD), formerly known as Ebola haemorrhagic fever, is
a severe, often fatal illness in humans with a death rate of up to 90%.
EVD outbreaks occur mostly in villages in Central and West Africa, near
tropical rainforests.
Transmission of the Ebola virus is primarily through direct contact with bodily
fluids of an infected individual or through exposure to objects like needles that
have been contaminated.
Ebola becomes contagious only when symptoms appear in infected people.
You cannot catch it from individuals without symptoms
Symptoms of EBV include: fever, headache, joint and muscle aches,
weakness, diarrhea, vomiting, stomach pain, lack of appetite and abnormal
bleeding.
Severely ill patients require intensive supportive care and health workers or
those in charge of their care need to take strict precautions to prevent spread
of the disease
Symptoms may appear anytime from two to 21 days after exposure to the
virus; most commonly, symptoms appear between eight and ten days after
exposure to the virus.
Ebola is not transmitted from contaminated food or water.
No licensed specific treatment or vaccine is available for use in people or
animals.
Why are we concerned about Ebola?
In March 2014 a new outbreak of EVD was reported in Liberia and New Guinea. The
disease has continued to spread and has now reached several surrounding states. A
number of health workers have been infected and some have been transported back
to the United States for treatment. EVD is a serious, often fatal disease and, if
unchecked, will continue to spread within the affected countries as well as across
borders. This outbreak is now the longest in history and on the 8th of August 2014 the
WHO declared the outbreak an international public health emergency.
The main countries affected by the disease lack adequate resources to manage the
situation and the WHO has called on the international community for help. Although
their advice is that "there should be no general ban on international travel or trade," it
issued a long list of recommendations on travel and contacts. This includes for all
travellers leaving the affected countries to be screened for fever, and no corpses to
be transported across borders. The Centre for Disease Control in Atlanta has issued
a level 3 travel alert advising people to avoid unnecessary travel to the region. The
president of Sierra Leone has ordered the quarantine of affected neighbourhoods
and house to house searches for people who might have been exposed to the virus.
Reports like this can be very confusing to the general public, who have to make
sense of the infection risks to themselves and their families, and who will be alarmed
by reports of the scary symptoms and deathly potential of this infection. In recent
years they have had to deal with threats from pandemics like ‘Swine Flu’ and stories
from newly emerging viruses like SARS. Global travel has increased the chances of
diseases spreading across borders and continents, and people are justifiably
concerned and need guidance on the real risks.
Although the threat of EVD in the affected countries is real and substantial, the risk in
currently unaffected countries is very low and should be kept in proportion. Ebola
transmission requires close contact with body fluids from infected persons, and the
risk to people visiting friends and relatives in affected countries is considered low.
What is Ebola Virus Disease?
Ebola Virus Disease (which used to be known by the name Ebola haemorrhagic
fever), is a severe illness in humans caused by Ebola virus. The virus causes fever,
vomiting and diarrhoea and sometimes internal bleeding and is fatal in up to 90% of
cases. It first appeared in 1976 in a village in what is now the Democratic Republic of
Congo near the Ebola River, which is how it received its name. EVD outbreaks occur
primarily in remote villages in Central and West Africa near tropical rainforests.
Ebola virus is part of the family of Filoviridae, genus Ebolavirus. There are five
identified subspecies of Ebolavirus. Four of the five have caused disease in humans:
Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï
Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus
(Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused
disease in nonhuman primates, but not in humans.
The natural reservoir of Ebola virus is thought to be fruit bats of the Pteropodidae
family. The virus was introduced to humans through close contact with the organs,
blood, and other bodily fluids of infected animals, such as chimpanzees, gorillas, fruit
bats and monkeys.
What are the symptoms of Ebola Virus Disease?
Symptoms of Ebola include fever, headache, joint and muscle aches, weakness,
diarrhea, vomiting, stomach pain, lack of appetite and abnormal bleeding. These may
appear any time from 2 to 21 days after exposure, but 8-10 days is the most
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common. Those who die have usually not developed a significant immune response,
but the reasons why some people recover and others don’t are not well understood.
There is no vaccine and no known cure for the disease. Although a highly
experimental monoclonal antibody, ‘ZMapp’, is showing promising results in
reversing the course of the disease in animals, the recent report of a ‘miracle’ cure of
a health worker with the antibody ZMAPP is incidental and there have been no
published results of human trials.
How is the virus transmitted?
The virus is transmitted by close contact with someone who is infected. It is assumed
that infection occurs by inhaling infected droplets (mucous and other body fluids)
from an infected person, or by touching the mouth with contaminated hands. This is
different from viral infections like influenza and colds which can be transmitted over
significant distances through droplet and aerosol transmission. It is assumed that
contamination of hands can occur through exposure to contaminated objects like
needles, clothing and other surfaces in close contact with the patient.
Public health England advise that infection can also occur if broken skin or mucous
membranes of a healthy person come into contact with environments that have
become contaminated with an Ebola patient’s infectious fluids such as soiled
clothing, bed linen, or used needles. Public Health England also advise that infection
generally does not occur through routine, social contact (such as shaking hands) with
asymptomatic individuals.
People most at risk are health workers or the family caring for an infected person.
This is because the more often a person is in contact with an infected person or
infected material from that person, the greater the risk. The disease can spread
quickly within health care settings when hospital staff are not wearing protective
equipment or fail to observe strict hygiene protocols.
The first infection in humans is thought to have happened through exposure to
infected animals.
Who is at risk and how can we contain the spread?
The likelihood of contracting any viral hemorrhagic fever (VHF), including Ebola is
considered extremely low unless there has been travel to the affected area and direct
contact with the blood or body fluids (e.g., saliva, urine) of symptomatic infected
persons or animals, or objects that have been contaminated with body fluids.
During outbreaks of EVD, those at highest risk of infection are people in close and
frequent contact with the patient. This includes health workers and the family and
friends of an infected person. This is different from viral infections like influenza and
colds which can be transmitted over significant distances through droplet and aerosol
transmission.
For anyone who cares for an Ebola-infected individual should observe strict
precautions as outlined by the WHO or other relevant Public Health bodies like Public
Health England. This includes wearing protective clothing such as face masks,
gowns and gloves and using disposable equipment wherever possible.
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It is not always possible to identify patients with EBV early because initial symptoms
such as a fever and a sore throat may be non-specific. For this reason, it is important
that health-care workers in countries with suspected or actual Ebola outbreaks apply
standard precautions consistently with all patients – regardless of their diagnosis – in
all work practices at all times. For healthcare workers these include basic hand
hygiene, respiratory hygiene, the use of personal protective equipment (according to
the risk of splashes or other contact with infected materials), safe injection practices
and safe burial practices.
Advice for non healthcare people (including families of infected people) living in
affected areas
•
As with other infectious illnesses, one of the most important preventive
practices is careful and frequent handwashing. Cleaning your hands often,
using soap and water (or waterless alcohol-based hand rubs when soap is
not available), removes potentially infectious materials from your skin and
helps prevent disease transmission.
•
Avoid close contact with infected persons
•
Surfaces which can transmit infection include surfaces which have become
contaminated with body fluids, including feeding utensils and clothing and
bedlinens from patients. Take advice from carers on how to handle and
decontaminate these items safely.
•
Take advice from local carers on safe disposal of body fluids and faecal
material.
•
Avoid contact with ill or dead animals, especially primates.
•
Do not eat “bushmeat” (wild animals, including primates, sold for consumption
as food in local markets).
Is there a risk from travelling on a flight with someone with Ebola?
You cannot catch Ebola through social contact or by travelling on a plane with
someone who is infected, without direct contact with the blood or body fluids of an
infected person. This is different from viral infections like influenza and colds which
can be transmitted over significant distances through droplet and aerosol
transmission.
The cause of fever in persons who have travelled in areas where VHF is present is
more likely to be a common infectious disease, but such persons should be
evaluated by a health-care provider to be sure.
If there are cases of Ebola in countries like UK, would we see an outbreak
similar to West Africa?
While the UK and other countries might see cases of imported Ebola, this is
extremely unlikely to result in a large outbreak in the UK. Countries like England
have healthcare systems with robust infection control systems and processes and
disease control systems that have a proven record of dealing with imported infectious
diseases.
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What is the advice for travellers?
The WHO issued the following guidance for travellers:
a. The risk of a tourist or businessman/woman becoming infected with Ebola virus during a visit to the
affected areas and developing disease after returning is extremely low, even if the visit included travel to
the local areas from which primary cases have been reported. Transmission requires direct contact with
blood, secretions, organs or other body fluids of infected living or dead persons or animal, all unlikely
exposures for the average traveller. Tourists are in any event advised to avoid all such contacts.
b. The risk for travellers visiting friends and relatives in affected countries is similarly low, unless the
traveller has direct physical contact with a sick or dead person or animal infected with Ebola virus. In
such a case, contact tracing should confirm the exposure and prevent further spread of the disease
through monitoring the exposed traveller.
c. The risk for fellow travellers or patient travellers: there is a possibility that a person who had been
exposed to Ebola virus and developed symptoms may board a commercial flight, or other mode of
transport, without informing the transport company of his status. It is highly likely that such patients
would seek immediate medical attention upon arrival, especially if well informed, and then should be
isolated to prevent further transmission. Although the risk to fellow travellers in such a situation is very
low, contact tracing is recommended in such circumstances.
d. There is a risk for healthcare workers and volunteers, especially if involved in caring for EVD patients.
However, if the recommended level of precaution for such settings is implemented, transmission of the
disease should be prevented. The risk level can be considered very low to low unless these precautions
are not followed, e.g. no personal protective equipment, needle stick injury etc.
References
• World health Organisation Interim Infection Control Recommendations for Care of
Patients with Suspected or Confirmed Filovirus (Ebola, Marburg) Haemorrhagic
Fever. March 2008
http://www.who.int/csr/bioriskreduction/filovirus_infection_control/en/
• NHS choices Ebola virus disease http://www.nhs.uk/conditions/ebolavirus/Pages/Ebola-virus.aspx
• Public Health England. Guidance: Ebola virus disease: risk assessment of
outbreak in West Africa July 2014
https://www.gov.uk/government/publications/ebola-virus-disease-risk-assessmentof-outbreak-in-west-africa
• Public health EnglandEbola virus disease: information for humanitarian aid
workers. https://www.gov.uk/government/publications/ebola-virus-diseaseinformation-for-humanitarian-aid-workers
• CDC Ebola Hemorrhagic Fever - Interim Guidance for Humanitarian Workers Jan
2014 www.cdc.gov/vhf/abroad/humanitarian-workers.html
IFH Guidelines and Training Resources on Home Hygiene
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Guidelines for prevention of infection and cross infection the domestic
environment. International Scientific Forum on Home Hygiene. Available from:
http://www.ifh-homehygiene.com/best-practice-care-guideline/guidelinesprevention-infection-and-cross-infection-domestic
Guidelines for prevention of infection and cross infection the domestic
environment: focus on issues in developing countries. International Scientific
Forum on Home Hygiene. Available from: http://www.ifh-homehygiene.org/bestpractice-care-guideline/guidelines-prevention-infection-and-cross-infectiondomestic-0
Recommendations for suitable procedure for use in the domestic environment
(2001). International Scientific Forum on Home Hygiene. http://www.ifhhomehygiene.org/best-practice-care-guideline/recommendations-suitableprocedure-use-domestic-environment-2001
Home hygiene - prevention of infection at home: a training resource for carers
and their trainers. (2003) International Scientific Forum on Home Hygiene.
Available from: http://www.ifh-homehygiene.com/best-practice-training/homehygiene-%E2%80%93-prevention-infection-home-training-resource-carers-andtheir
Home Hygiene in Developing Countries: Prevention of Infection in the Home and
Peridomestic Setting. A training resource for teachers and community health
professionals in developing countries. International Scientific Forum on Home
Hygiene. Available from: www.ifh-homehygiene.org/best-practice-training/homehygiene-developing-countries-prevention-infection-home-and-peri-domestic.
(Also available in Russian, Urdu and Bengali)
This fact sheet was last updated in 2014
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