1. Ebola Virus Disease

2. EVD Description Hemorrhagic fever with case fatality rate up to 90% Endemic areas: Central and West Africa Wildlife reservoir: bats implicated No cases in humans ever reported in U.S.

3. Transmission Direct contact with bodily fluids from infected person or contaminated objects (e.g. needles) Incubation period: usually 8-10 days (range 2-21 days) High-risk individuals –Health care workers –Family members or others in close contact with EVD patients Can spread quickly in health care settings

4. Signs and Symptoms Early signs non-specific: fever, malaise, weakness, muscle pain, headache, sore throat, vomiting, diarrhea Late signs: bleeding, multi-organ dysfunction leading to shock and death

5. Diagnosis Complicated by non-specific early symptoms BSL-3 lab required (BSL-4 for virus isolation) Timeline of infectionDiagnostic tests available Within a few days after onset  Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing  IgM ELISA  Polymerase chain reaction (PCR)  Virus isolation Later in disease course or after recovery  Serology: IgM and IgG Retrospectively in deceased patients  Immunohistochemistry testing  PCR  Virus isolation

6. Response Treatment –Supportive only –Prompt treatment important Prevention –Standard, contact, droplet precautions –Contact tracing, monitoring for 21 day incubation period –Immediate isolation of ill contacts –Disinfection of contaminated surfaces, objects by standard methods –No vaccine available

7. Public Health Messaging Identify population at-risk: those with recent history of travel to endemic areas Health care providers –Should have low threshold of suspicion among travelers returning from endemic areas –Barrier precautions successfully prevent spread Travelers –Should be aware of risk of EVD in endemic areas –Avoid exposure to risk factors (caves or mines inhabited by bats, healthcare settings where EVD is present, close contact with EVD patients)