If patient evaluation, based on relevant travel and/or exposure history AND clinical criteria, indicates possible Ebola virus disease (EVD), implement rapid isolation with immediate contact of public health authorities. Medical evaluation is required.
See Diagnostic Pearls for case definition and exposure risk factors.
Precautions: A patient with known or suspected Ebola virus disease (EVD) should be isolated in a single room (with a private bathroom), and health care personnel should follow standard, contact, and droplet / airborne precautions including the use of appropriate personal protective equipment (PPE) for all persons entering the patient room (in practice, CDC recommendations include use of an N-95 respirator or powered air purifying respirator [PAPR], as the virus can aerosolize in specific situations). Use only essential healthcare workers trained in their designated roles for patient care and keep a log of everyone who enters and leaves the patient's room. Perform only necessary tests and procedures and avoid aerosol-generating procedures.
Notify your facility's Infection Prevention and Control Program and other healthcare personnel of a suspected EVD case. Contact the local or state health department for consultation about testing for EVD.
Testing: The decision to test for Ebola should be made in consultation with relevant health department. Hospitals should follow their state and/or local health department procedures for notification and consultation. Due to biosafety precautions for suspected Ebola, blood should only be drawn and processed at appropriately equipped facilities.
2022 Uganda outbreak: On September 20, 2022, the Ugandan Ministry of Health confirmed an outbreak of Ebola virus disease (EVD) (Sudan ebolavirus) in Mubende District, in western Uganda. As of November 6, 2022, Ebola infections are confirmed in 8 districts (Bunyangabu, Kagadi, Kampala, Kassanda, Kyegegwa, Masaka, Mubende, Wakiso). As of November 5, 2022, a total of 132 confirmed Ebola cases with 53 confirmed deaths (case fatality rate of 40%) and 61 recoveries had been reported.
2014 West Africa outbreak: The 2014-2016 Ebola epidemic in West Africa, caused by Zaire ebolavirus, included Liberia, Guinea, and Sierra Leone. It was the largest in history. Travel-associated cases were reported in Nigeria, Spain, Italy, the United States, the United Kingdom, Mali, and Senegal. The second-largest outbreak occurred in the Democratic Republic of the Congo in 2018-2020.
About Ebola: Ebola virus is an RNA virus of the Filoviridae family endemic to Asia and Africa. It is closely related to Marburg virus and is a zoonotic (animal-borne) infection. Ebola virus is believed to be transmitted to humans by contact with blood, secretions, organs, or other bodily fluids of infected animals such as non-human primates (monkeys, gorillas, chimpanzees).
The mortality rate of naturally occurring Ebola is approximately 25%-90%, depending on the infecting viral strain. Individuals who recover from EVD develop antibodies lasting for 10 or more years. There are 5 identified strains of Ebola virus: the Zaire strain, the Sudan strain, the Tai Forest strain, the Reston strain, and the Bundibugyo ebolavirus strain. rVSV-ZEBOV (Ervebo) is an Ebola vaccine approved by the US Food and Drug administration (FDA) for prevention of Zaire ebolavirus. It does not provide protection against the Sudan, Tai Forest, Reston, or Bundibugyo ebolavirus strains.
Transmission: Ebola is a life-threatening infection that causes a virulent viral hemorrhagic fever. Person-to-person transmission of EVD occurs through direct contact with blood or body secretions (such as urine, saliva, feces, vomit, breast milk, and semen), including the bodily fluids of the deceased. The ability to transmit the virus via semen may persist for up to several years and could be a source of a new outbreak. The virus gains entry via mucous membranes, breaks in the skin, or parenterally. The incubation period for Ebola is 2-21 days (usually about 7 days). Humans are not infectious until they develop symptoms. Individual patient relapses may be sources of mini-epidemics.
Signs and Symptoms: Initial symptoms of EVD include the sudden onset of 4-7 days of fever, chills, headache, weakness, myalgias, rash, nausea, vomiting, chest pain, cough, sore throat, prostration, conjunctivitis, abdominal pain, and diarrhea. The disease may progress to jaundice, pancreatitis, anorexia, photophobia, delirium, shock, liver failure, hemorrhaging, and multi-system dysfunction.
A98.4 – Ebola virus disease
37109004 – Ebola hemorrhagic fever
Differential Diagnosis & Pitfalls
In the absence of hemorrhagic findings, all other tropical fevers and worldwide causes of fever with or without rash must be ruled out.
- Yellow fever
- Marburg Filoviridae virus infection
- Crimean-Congo hemorrhagic fever
- Typhoid fever
- Rift Valley fever
- Omsk hemorrhagic fever
- Epidemic typhus
- Endemic typhus
- Acute meningococcemia
- Lassa fever
- Hantavirus hemorrhagic fever with renal syndrome
- Rocky Mountain spotted fever
- Fulminant hepatic necrosis
- Kyasanur Forest disease
- Dengue hemorrhagic fever
- Argentine hemorrhagic fever
- Bolivian hemorrhagic fever
- Sabia virus
- Venezuelan hemorrhagic fever