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Ministry of Health and Long-Term Care Ontario Ebola Virus Disease (EVD) Outbreak Case Definition – May 2016 Population and Public Health Division Important Note: These specific EVD case definitions for Ontario have been created based on the outbreak activity that has occurred in West Africa since 2014. Note that these case definitions are for surveillance purposes and recording in the integrated Public Health Information System (iPHIS). These surveillance case definitions are not intended to replace clinician or public health practitioner judgment in individual patient management, or intended to be used for the purpose of infection control triage. Please see MOHLTC website www.ontario.ca/ebola for current information on affected village/areas. Clinically compatible symptoms for new EVD infection are defined as one or more of the following: Clinically compatible symptoms of EVD relapse are defined as one or more of the following1: • Fever ≥ 38.0 degrees Celsius; • Fever ≥ 38.0 degrees Celsius; • Malaise; • • Myalgia; • Severe headache; Ocular symptoms such as eye pain, redness, sensitivity to light, and/or blurry vision • Conjunctival injection; • • Pharyngitis; Neurologic symptoms such as headache, neck stiffness, photophobia, altered mental status, and/or seizures • Abdominal pain; • Vomiting; • Diarrhea that can be bloody; • Unexplained hemorrhage; • Rash 1 Note that Ebola virus has been found to persist in EVD survivors in sites that are harder for the immune system to reach (immunologically privileged sites) (e.g., eyes, central nervous system, male reproductive tract and mammary glands). Therefore finding virus in an immunologically privileged site would not constitute a relapse unless the patient is symptomatic. Person Under Investigation Confirmed Cases New Infection New Infection A person, previously NOT known to have Ebola virus disease (EVD), with clinically compatible symptoms for new infection (as defined above) with one of the following EVD exposures within the 21 days before onset of symptoms AND with laboratory results pending: A person, previously NOT known to have Ebola virus disease, with clinically compatible symptoms for new EVD infection and laboratory confirmation of Ebola virus infection using at least one of the methods below: • Direct or close contact with a person or a recently deceased person known or highly likely to have EVD or their blood or body fluids with or without full, appropriate personal protective equipment at all times OR • • Isolation and identification of virus from an appropriate clinical specimen (e.g. blood, serum, tissue, urine specimens or throat secretions) OR • Sexual contact with a man previously diagnosed with EVD since December 2013 (regardless of condom use) Detection of virus-specific RNA by reverse-transcriptase PCR from an appropriate clinical specimen (e.g. blood, serum, tissue) using two independent targets or two independent samples OR OR • • In the 21 days prior to symptom onset, lived in or visited a village/area where EVD transmission has occurred in the preceding three months Person Under Investigation Relapse A person previously known to have EVD and to have cleared their infection 2 who presents with clinically compatible symptoms of a relapse (as defined above) AND with laboratory results pending or not available. 2 Infection is considered to have been cleared when the patient has been assessed as non-infectious and discharged from EVD-specific care based on two negative Ebola PCR tests performed by an accredited laboratory Demonstration of virus antigen in tissue (e.g. skin, liver or spleen) by immunohistochemical or immunofluorescent techniques AND another test (e.g. PCR) OR • Demonstration of specific IgM AND IgG antibody by EIA, immunofluorescent assay or Western Blot OR • Demonstration of a fourfold rise in IgG serum antibody by EIA, immunofluorescent assay or Western Blot from serial samples 2 Confirmed Cases Relapse 3 A person, previously known to have Ebola virus disease and to have cleared their infection 4, who presents with symptoms compatible with a relapse of EVD (as defined above) and has laboratory confirmation of Ebola virus infection using at least one of the methods below: • Isolation and identification of virus from an appropriate clinical specimen (e.g., site clinically involved with relapse based on symptoms, or blood or serum) OR • Detection of virus-specific RNA by reverse-transcriptase PCR from an appropriate clinical specimen (e.g., site clinically involved with relapse based on symptoms or blood or serum) using two independent targets or two independent samples OR • Demonstration of virus antigen in tissue clinically involved with the relapse (e.g., eye, brain, testes) by immunohistochemical or immunofluorescent techniques AND another test (e.g. PCR) 3 This is an interim definition and may be subject to change 4 Infection is considered to have been cleared when the patient has been assessed as non-infectious and discharged from EVD-specific care based on two negative Ebola PCR tests performed by an accredited laboratory 3