Clinical Guidance for Ebola Disease

Key points

  • Do not delay testing for other more likely medical conditions when assessing for Ebola disease.
  • Notify your health department if you suspect a patient may have Ebola disease.
  • It is essential you wear proper PPE and take infection control measures while assessing a patient with suspect Ebola disease.
  • FDA-approved treatments for Ebola infection are available.
  • An FDA-approved vaccine is available for people who meet qualifying criteria.

Guiding principles

Ebola disease is rare in the U.S.

Most ill travelers returning from an area with an active Ebola disease outbreak or where Ebola disease is endemic are usually ill with a more common infection, such as malaria. Timely identification of other more likely pathogens and access to routine laboratory testing, such as blood counts and chemistries, is essential for providing appropriate patient care.

In the hospital setting, where policies and procedures should be in place to safeguard healthcare workers, consideration of Ebola disease should not delay diagnostic assessments, laboratory testing, and appropriate care for other, more likely medical conditions.

Appropriate screening is essential

Early consideration of Ebola disease in the differential diagnosis of a patient with consistent clinical and epidemiological factors is essential for providing appropriate and prompt patient care and preventing the spread of infection. It is important to systematically assess patients through a screening process and treat infections as they are discovered.

Notify your health department

Healthcare providers with concerns about Ebola infection during their patient's differential diagnosis should contact their jurisdictional health department immediately (via the 24-hour Epi-On-Call contact list) and follow jurisdictional protocols for patient assessment.

Clinical teams should coordinate with public health officials and CDC to assess the risk of Ebola disease based on the clinical presentation and epidemiologic risk factors. This will help determine if testing is needed and what other causes of illness should be considered (e.g., malaria). This coordination can ensure proper patient care and appropriate precautions are taken to help prevent potential spread within the healthcare setting.

CDC's Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations on Ebola disease by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB's on-call epidemiologist.

Healthcare providers:‎

Review guidance on emergency services, screening, testing, infection control and PPE for viral hemorrhagic fevers, like Ebola disease, here: Site Index | Viral Hemorrhagic Fevers (VHFs) | CDC

Evaluation

Screening resources

Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease
Healthcare providers can learn how to evaluate an ill person for a VHF or other high-consequence dis...
Clinical Screening and Diagnosis for VHFs
Healthcare providers can learn how to screen patients for VHFs

Preventing infection

Guidance for Personal Protective Equipment (PPE)
The following informational materials demonstrate the procedures for putting on and removing PPE for...
Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF)
Guidance for hospital staff caring for a patient who is suspected or confirmed to have viral hemorrh...

Ebola Vaccine Product Information
Healthcare providers can learn about the ERVEBO Ebola vaccine product information.

Orthoebolaviruses enter a person's body through mucous membranes, breaks in the skin, or parenterally. They infect many cell types – monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells, and epithelial cells. The incubation period may vary depending on the infection route.

Once in the body, orthoebolaviruses migrate from the initial infection site to regional lymph nodes. They then migrate to the liver, spleen, and adrenal gland. Although not infected by an orthoebolavirus, lymphocytes undergo apoptosis, resulting in decreased lymphocyte counts. Hepatocellular necrosis occurs and is associated with dysregulation of clotting factors and subsequent coagulopathy. Adrenocortical necrosis can be found and is associated with hypotension and impaired steroid synthesis.

Ebolaviruses appear to trigger a release of pro-inflammatory cytokines. Subsequent vascular leaks and impairment of clotting ultimately result in multiorgan failure and shock.

Treatment options

Two treatments are approved by the U.S. Food and Drug Administration (FDA) to treat Ebola disease caused by Ebola virus (species Zaire orthoebolavirus). Inmazeb® is a combination of three monoclonal antibodies and Ebanga® is a single monoclonal antibody. Monoclonal antibodies, or mAbs, are artificially produced antibodies that act like natural antibodies to stop the virus from replicating in a person's body. These mAbs bind to a portion of the virus called the glycoprotein and prevent the virus from entering the person's cells.

Both treatments were evaluated, along with two others, in a randomized controlled trial in the Democratic Republic of the Congo. Overall survival was higher for patients who received either Inmazeb® or Ebanga®. The efficacy of these treatments has not been established for viruses other than Ebola virus (species Zaire orthoebolavirus).

Clinical management of patients with Ebola disease should focus on supportive care for complications, such as hypovolemia, electrolyte abnormalities, hematologic abnormalities, refractory shock, hypoxia, hemorrhage, septic shock, multiorgan failure, and disseminated intravascular coagulation (DIC).

Recommended care includes volume repletion, maintenance of blood pressure (with vasopressors if needed), and maintenance of oxygenation, pain control, nutritional support, and treatment of secondary bacterial infections and pre-existing comorbidities.

Large volumes of intravenous fluids are often required to correct dehydration due to diarrhea and vomiting. Some patients may develop profound third-spacing of fluids due to vascular leak.

Complications

Ebola survivors can have many chronic complications, including viral persistence of orthoebolavirus in their bodies.

Keep Reading: Caring for Ebola Disease Survivors in the U.S.

Management for specific populations

Clinical Guidance for Ebola in People Who Are Pregnant
Guidance on how to screen people who are pregnant for Ebola virus disease.

VHF Clinical Care for Safely Performing Acute Hemodialysis in Patients in U.S. Hospitals
Recommendations to help hospital-based dialysis providers safely perform hemodialysis in patients wi...
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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  • Ansumana R, Jacobsen KH, Sahr F, Idris M, Bangura H, Boie-Jalloh M et al. Ebola in Freetown area, Sierra Leone—a case study of 581 patients. N Engl J Med. 2015 Feb 5;372(6):587–8.
  • Bah EI, Lamah MC, Fletcher T, Jacob ST, Brett-Major DM, Sall AA et al. Clinical Presentation of Patients with Ebola Virus Disease in Conakry, Guinea. N Engl J Med. 2015 Jan 1;372(1):40–7.
  • Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N et al. Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med. 2014 Oct 9;371(15):1418–25.
  • Brett-Major DM, Jacob ST, Jacquerioz FA, Risi GF, Fischer WA 2nd, Kato Y et al. Beng Ready to Treat Ebola Virus Disease Patients. Am J Trop Med Hyg. 2015 Feb 4;92(2):233–7.
  • Chertow DS, Kleine C, Edwards JK, Scaini R, Giuliani R, Sprecher A. Ebola Virus Disease in West Africa—Clinical Manifestations and Management. N Engl J Med. 2014 Nov 27;371(22):2054–7.
  • Chertow DS, Nath A, Suffredini AF, Danner RL, Reich DS, Bishop RJ, Childs RW, Arai AE, Palmore TN, Lane HC, Fauci AS, Davey RT. Severe Meningoencephalitis in a Case of Ebola Virus Disease: A Case Report. Ann Intern Med. 2016 Apr 5. doi: 10.7326/M15–3066.
  • Feldmann H, Geisbert TW. Ebola Haemorrhagic Fever. Lancet. 2011 Mar 5;377(9768):849–62.
  • Fitzpatrick G, Vogt F, Moi Gbabai OB, Decroo T, Keane M, De Clerck H et al. The Contribution of Ebola Viral Load at Admission and Other Patient Characteristics to Mortality in a Médecins Sans Frontières Ebola Case Management Centre, Kailahun, Sierra Leone, June–October 2014. J Infect Dis. 2015 Dec 1;212(11):1752–8.
  • Florescu DF, Kalil AC, Hewlett AL, Schuh AJ, Stroher U, Uyeki TM et al. Administration of Brincidofovir and Convalescent Plasma in a Patient With Ebola Virus Disease. Clin Infect Dis. 2015 Sep 15;61(6):969–73.
  • Fowler RA, Fletcher T, Fischer WA 2nd, Lamontagne F, Jacob S, Brett-Major D et al. Caring for Critically Ill Patients with Ebola Virus Disease: Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733–7.
  • Hunt L, Gupta-Wright A, Simms V, Tamba F, Knott V, Tamba K et al. Clinical presentation, biochemical, and hematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study. Lancet Infect Dis. 2015 Nov;15(11):1292–9.
  • Jacobs M, Aarons E, Bhagani S, Buchanan R, Cropley I, Hopkins S et al. Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers. Lancet Infect Dis. 2015 Nov;15(11):1300–4.
  • Johnson DW, Sullivan JN, Piquette CA, Hewlett AL, Bailey KL, Smith PW et al. Lessons Learned: Critical Care Management of Patients With Ebola in the United States. Crit Care Med. 2015 Jun;43(6):1157–64.
  • Kortepeter MG, Bausch DG, Bray M. Basic Clinical and Laboratory Features of Filoviral Hemorrhagic Fever. J Infect Dis. 2011 Nov;204 Suppl 3:S810–6.
  • Kraft CS, Hewlett AL, Koepsell S, Winkler AM, Kratochvil CJ, Larson L, et al. The Use of TKM-100802 and Convalescent Plasma in 2 Patients With Ebola Virus Disease in the United States. Clin Infect Dis. 2015 Aug 15;61(4):496–502.
  • Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, et al. A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia. N Engl J Med. 2014 Dec 18;371(25):2394–2401.
  • Lai L, Davey R, Beck A, Xu Y, Suffredini AF, Palmore T wt al. Emergency Postexposure Vaccination With Vesicular Stomatitis Virus-Vectored Ebola Vaccine After Needlestick. JAMA. 2015 Mar 24–31;313(12):1249–55.
  • Liddell AM, Davey RT Jr, Mehta AK, Varkey JB, Kraft CS, Tseggay GK et al. Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States. Ann Intern Med. 2015 Jul 21;163(2):81–90.
  • Lyon GM, Mehta AK, Varkey JB, Brantly K, Plyler L, McElroy AK et al. Clinical Care of Two Patients with Ebola Virus Disease in the United States. N Engl J Med. 2014 Dec 18;371(25):2402–2409.
  • Mora-Rillo M, Arsuaga M, Ramírez-Olivencia G, de la Calle F, Borobia AM, Sánchez-Seco P et al. Acute respiratory distress syndrome after convalescent plasma use: treatment of a patient with Ebola virus disease contracted in Madrid, Spain. Lancet Respir Med. 2015 Jul;3(7):554–62.
  • Parra JM, Salmerón OJ, Velasco M. The First Case of Ebola Virus Disease Acquired outside Africa. N Engl J Med. 2014 Dec 18;371(25):2439–40.
  • Qin E, Bi J, Zhao M, Wang Y, Guo T, Yan T et al. Clinical Features of Patients With Ebola Virus Disease in Sierra Leone. Clin Infect Dis. 2015 Aug 15;61(4):491–5.
  • Sagui E, Janvier F, Baize S, Foissaud V, Koulibaly F, Savini H et al. Severe Ebola Virus Infection With Encephalopathy: Evidence for Direct Virus Involvement. Clin Infect Dis. 2015 Nov 15;61(10):1627–8.
  • Schibler M, Vetter P, Cherpillod P, Petty TJ, Cordey S, Vieille G et al. Clinical features and viral kinetics in a rapidly cured patient with Ebola virus disease: A case report. Lancet Infect Dis. 2015 Sep;15(9):1034–40.
  • Schieffelin JS, Shaffer JG, Goba A, Gbakie M, Gire SK, Colubri A et al. Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. N Engl J Med. Nov 27;371(22):2092–100.
  • Sueblinvong V, Johnson DW, Weinstein GL, Connor MJ Jr, Crozier I, Liddell AM et al. Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States. Crit Care Med. 2015 Oct;43(10):2066–75.
  • Uyeki TM, Mehta AK, Davey RT Jr, Liddell AM, Wolf T, Vetter P et al. Clinical Management of Ebola Virus Disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636–46.
  • WHO Ebola Response Team, Agua-Agum J, Ariyarajah A, Blake IM, Cori A, Donnelly CA, Dorigatti I et al. Ebola virus disease among children in West Africa. N Engl J Med. 2015 Mar 26;372(13):1274–7.
  • WHO Ebola Response Team. Ebola Virus Disease in West Africa—The First Nine Months of the Epidemic and Forward Projections. N Engl J Med. 2014 Oct 16;371(16):1481–95.
  • WHO Ebola Response Team. West African Ebola Epidemic after One Year—Slowing but Not Yet under Control. N Engl J Med. 2015 Feb 5;372(6):584–7.
  • ong KK, Davey RT Jr, Hewlett AL, Kraft CS, Mehta AK, Mulligan MJ, Beck A, Dorman W, Kratochvil CJ, Lai L, Palmore TN, Rogers S, Smith PW, Suffredini AF, Wolcott M, Ströher U, Uyeki TM. Use of post-exposure prophylaxis after occupational exposure to Zaire ebolavirus. Clin Infect Dis. 2016 Apr 26. pii: ciw256.