Ebola Facts October 14, 2014

Symptoms of Ebola • Initial symptoms are nonspecific - may include fever, chills, myalgias, and malaise. • Patients can progress to develop gastrointestinal symptoms:

– severe watery diarrhea, nausea, vomiting, abdominal pain • Other symptoms:

– chest pain, shortness of breath, headache or confusion, conjunctival injection, hiccups, seizures, and cerebral edema

• Bleeding not universally present but can manifest later as petechiae, ecchymosis/ bruising, or oozing. Frank hemorrhage less common.

• Some develop diffuse erythematous maculopapular rash that can desquamate. • Most common symptoms reported during current outbreak:

– fever (87%) – fatigue (76%) – vomiting (68%) – diarrhea (66%) – loss of appetite (65%)

• Patients with fatal disease develop more severe clinical signs early during infection and die between days 6 - 16 of complications (mean of 7.5 days).

• In non-fatal cases, patients may have fever for several days and improve, around day 6. • The case fatality proportion in West Africa is about 71%

Source: Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html

Diagnosis of Ebola

Timeline of Infection Diagnostic tests available

Within a few days after symptoms begin

•Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing •IgM ELISA •Polymerase chain reaction (PCR) •Virus isolation

Later in disease course or after recovery •IgM and IgG antibodies

Retrospectively in deceased patients •Immunohistochemistry testing •PCR •Virus isolation

• Diagnosing Ebola can be difficult at first since early symptoms, such as fever, are nonspecific to Ebola infection.

• However, if a person has the early symptoms and has had contact with Ebola they should be isolated and public health professionals notified.

• Samples from the patient can then be collected and tested to confirm infection.

Source: Centers for Disease Control and Prevention http://www.cdc.gov/vhf/ebola/diagnosis/index.html

Source: http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf

Treatment of Ebola • There are no approved treatments available for EVD. • Clinical management focus - supportive care of complications:

– hypovolemia, electrolyte abnormalities, hematologic abnormalities, refractory shock, hypoxia, hemorrhage, septic shock, multi-organ failure, and DIC.

• Recommended care includes:

– volume repletion – maintenance of blood pressure (with vasopressors if needed) – maintenance of oxygenation – pain control – nutritional support – treating secondary bacterial infections and pre-existing comorbidities

• Among patients from West Africa, large volumes of intravenous fluids have often been required to

correct dehydration due to diarrhea and vomiting.

• Several investigational therapeutics for Ebola virus disease are in development. There are no approved vaccines available for EVD. Several investigational Ebola vaccines are in development, and Phase I trials are underway for some vaccine candidates.

Source: Centers for Disease Control and Prevention. http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html

Source: http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf

References • Baize S. et al. Emergence of Zaire Ebola Virus Disease in Guinea -

Prepminary Report. N Engl J Med. 2014 Apr 16. epub • Feldmann H , Geisbert TW. Ebola Haemorrhagic Fever. Lancet.

2011 Mar 5;377(9768):849-62. • Fowler RA, Fletcher T, Fischer WA, et al. Caring for Critically Ill

Patients with Ebola Virus Disease: Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Aug 25. Epub

• Kortepeter MG, Bausch DG, Bray M. Basic Cpnical and Laboratory Features of Filoviral Hemorrhagic Fever. J Infect Dis. 2011 Nov;204 Suppl 3:S810-6

• WHO Ebola Response Team. Ebola Virus Disease in West Africa – The First 9 Months of the Epidemic and Forward Projections. N Eng J Med. 2014 Sept 23. Epub

Source: http://www.cdc.gov/vhf/ebola/index.html