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Communicable Disease Advisory:
Ebola Virus Disease
(formerly Ebola Haemorrhagic Fever)
Date: August 8, 2014
This advisory contains critical information. Please read carefully.
Context:
The Ebola virus disease (EVD) outbreak continues to evolve in Sierra Leone, Liberia, Guinea and
Nigeria, with continuing community and health-facility transmission of infection. As of August 4, the
cumulative number of cases attributed to EVD in the four countries is over 1700, with more than
900 deaths. (www.who.int/csr/don/archive/disease/ebola/en/)
The virus is transmitted to humans from contact with infected wild animals (fruit bats are the
possible reservoir, non-human primates and pigs are accidental hosts), and from human to human
through direct contact (through non-intact skin or mucous membranes) with blood, other body
fluids and tissues of infected persons, and indirect contact with environmental items contaminated
with such fluids. In health care settings, transmission occurs as a result of close contact with
infected patients without appropriate infection control precautions in place. The incubation period
ranges from 2-21 days, and the period of communicability extends from symptom onset to
symptom resolution.
The risk of EVD coming to Canada is considered very low. However, please maintain a high index
of suspicion for individuals meeting BOTH the following exposure and illness criteria:
Exposure criteria: Residence in or travel to Guinea, Sierra Leone, Liberia, Nigeria or other EVDaffected areas within 21 days prior to fever onset, AND
Clinical illness criteria: Sudden onset of fever greater than 38.6°C, AND additional symptoms
such as intense weakness, muscle pain, severe headache, followed by vomiting, diarrhea that
can be bloody, abdominal pain; often accompanied by maculopapular or petechial rash on chest,
back and stomach that may progress to purpura; occasionally with unexplained internal and
external haemorrhage
These individuals should be immediately triaged and isolated appropriately (see Actions).
Case Definitions:
Confirmed case – Suspect or probable case with laboratory confirmation of EVD infection (only
through testing done in the CL4 laboratory at the National Microbiology Laboratory)
Probable case - Clinical illness and a history within the three weeks before onset of fever of one of
the following:
• travel in a specific area of a country where an outbreak of EVD has recently occurred,
• contact with a suspect, probable or confirmed case of EVD
• direct contact with blood or other body fluid secretions or excretions of a person or animal
with a confirmed or probable case of EVD, or
• work in a laboratory or animal facility that handles EVD.
Suspect case – Clinical illness only
Actions:
1. Immediately triage and place patient in single room (with private bathroom) with the door closed.
Implement Infection Prevention and Control measures, including contact and droplet precautions
for any patient meeting the above exposure and clinical illness criteria. See
www.albertahealthservices.ca/6854.asp
o Infectious Substances: Blood; Body Fluids; Respiratory Secretions
o How is it Transmitted: Direct Contact; Indirect Contact; Inhalation of Respiratory Droplets
o Precautions Needed:
Communicable Disease Advisory:
Ebola Virus Disease
(formerly Ebola Haemorrhagic Fever)
Date: August 8, 2014
Routine Practices 1 + Contact 2 + Droplet 3 Precautions
Airborne-Precautions (fit-tested N95 Respirator) for Aerosol Generating Medical
Procedures (AGMPs - eg. Intubation; CPR; Bronchoscopy) 4
o Duration of Precautions: Period of communicability is uncertain; maintain precautions until
symptoms resolve
o Patient Placement and Equipment:
 Single room with private bathroom required. Airborne (Negative Pressure) isolation room
is preferred, and is essential for AGMPs.
 Use dedicated (ideally disposable) patient-care medical equipment. All reusable patientcare equipment must be cleaned and disinfected/sterilized according to manufacturer’s
instructions.
o Environmental Infection Control:
 PPE as for Contact and Droplet Precautions should be worn by environmental cleaning
staff when cleaning rooms and when disposing of liquid waste.
 Approved hospital disinfectants are appropriate for environmental cleaning (of surfaces
and non-critical medical devices)
2. Notify North Zone Medical Officer of Health (MOH) immediately at:
During regular office hours (08h30 – 16h30; Monday through Friday)
– phone North Zone CDC Intake at: 1-855-513-7530
After hours, weekends, stat holidays
– phone North Zone Public Health On Call at: 1-800-732-8981
3. Contact your site’s Infection Control Practitioner for additional assistance as applicable.
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Laboratory testing:
ANY and ALL laboratory testing MUST be coordinated through the local zone MOH.
Additional References:
World Health Organization. EVD www.who.int/csr/disease/ebola/en/
Public Health Agency of Canada.
• Ebola Virus Disease: www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-eng.php
• Travel Advisory: www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=125
Centers for Disease Control and Prevention. www.cdc.gov/vhf/ebola/index.html
Alberta Health Services. www.albertahealthservices.ca/ebola, www.albertahealthservices.ca/7082.asp
James Talbot, MD, PhD, FRCPC
Chief Medical Officer of Health
Alberta Health
Gerry Predy, MD, FRCPC
Senior Medical Officer of Health
Alberta Health Services
Dr. Albert S. de Villiers, MB.Ch.B., M.Med. (C.H.)
Medical Officer of Health, North Zone Lead
Alberta Health Services
1
Risk Assessment (circumstances of the patient, environment and tasks to be performed dictate appropriate PPE) + meticulous Hand
Hygiene before/after patient contact, after contact with contaminated surfaces and after removal of PPE; limit use of sharps, do
not recap and dispose carefully in sharps container
2
Gloves + Fluid Resistant (Impermeable) Gown to cover clothing and exposed skin; closed shoes to protect feet with use of shoe
covers if exposure to copious body fluids is anticipated
3
Facial Protection to prevent splashes to the mouth, nose and eyes – Surgical Mask and Goggles or Facial Shield
4
Avoid AGMPs if at all possible (eg. BiPAP; nebulized medications; sputum induction; open tracheal suctioning)