Health Professionals

Clinical Updates

1 May 2014

Ebola virus disease: West Africa - update

This updates the Clinical Update of 17 April 2014

The outbreak of Ebola virus disease (EVD) in Guinea is ongoing. As of 26 April 2014, a total of 224 cases, including 143 deaths, have been reported to the World Health Organization (WHO), of which 121 cases have been laboratory confirmed. Cases have been reported from the capital (Conakry) and the districts of Dabola, Djingaraye, Guékédou, Kissidougou and Macenta [1].

WHO describes the epidemiological situation in Guinea as improving significantly in some areas over the past few weeks. However, as the incubation period for EVD can be up to three weeks, it is likely that Guinea will report new cases in the coming weeks. Additional suspected cases may also be identified in neighbouring countries [2].

As of 24 April 2014, Liberia has reported a total of 35 clinically compatible cases of EVD, including six confirmed cases, two probable cases and 27 suspected cases. The date of onset for the most recent confirmed case was 6 April 2014 [2].

The Ministry of Health and Sanitation of Sierra Leone is currently investigating three patients with an illness compatible with a viral haemorrhagic fever. As of 24 April 2014, all samples from suspected cases have tested negative for EVD [2].

Isolation of cases, active monitoring of contacts and other control measures currently being implemented in the affected countries are expected to control this outbreak and prevent further spread of EVD [3].

WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia or Sierra Leone [2]. No cases have been detected in returning travellers in Europe [3].

Ebola virus disease

Ebola virus disease is a severe disease caused by a virus of the Filoviridae family. The natural reservoir for Ebola virus is not known, but it has been found in animals including non-human primates and bats [4].

Following an incubation period of four to 16 days (range two to 21 days) illness presents with the sudden onset of fever, headache, joint and muscle aches and weakness. As the infection progresses, nausea, vomiting and diarrhoea, shortness of breath, confusion and haemorrhage can occur. This can lead to multi-organ failure, shock and death.

Most human infections result from direct contact with bodily fluids or secretions from an infected human. The highest risks of infection are associated with caring for infected patients, particularly in hospital settings [3]. Ebola has also been reported following contact with the tissues of infected animals such as non-human primates and bats.

Advice for travellers

There has never been an imported case of Ebola reported in the United Kingdom [6]; the risk to most travellers to affected countries in West Africa is considered very low [3, 4]. The highest risks of infection are associated with caring for infected patients, particularly in hospital settings, unprotected exposure to contaminated bodily fluids, and unsafe medical procedures, including exposure to contaminated medical devices, such as needles and syringes.

It is recommended that the following precautions are taken by travellers to areas with on-going cases:

  • Avoid contact with symptomatic patients and their bodily fluids
  • Avoid contact with corpses and/or bodily fluids from deceased patients
  • Avoid close contact with alive or dead wild animals (including monkeys, forest antelopes, rodents and bats)
  • Avoid consumption of "bushmeat"
  • Wash and peel fruits and vegetables before consumption
  • Practise safe sex
  • Follow strict hand washing routines [5].

Travellers who have been potentially exposed to Ebola virus should seek medical attention immediately if they experience any symptoms consistent with Ebola within the first 21 days of return to the UK.

Those who are providing medical care or are involved in the evaluation of an outbreak should observe strict barrier precautions. 

Guidance for healthcare workers who will be working with VHF patients in African healthcare settings has been written by the CDC in conjunction with WHO.

The Imported Fever Service: Public Health England is available to local infectious disease physicians or microbiologists should specialist advice be needed on 0844 7788990. United Kingdom guidance on the management and control of viral haemorrhagic fevers (VHF) has been written by the Advisory Committee on Dangerous Pathogens.

References

1. World Health Organization. Global Alert and Response. Disease Outbreak News Regional Office for Africa. Ebola virus disease, West Africa - update.  28 April 201. [Accessed 1 May 2014]. Available at:

http://www.who.int/csr/don/2014_04_28_ebola/en/

2. World Health Organization. Global Alert and Response. Disease Outbreak News. Ebola virus disease, West Africa - update. 25 April 2014. [Accessed 1 May 2014]. Available at:

http://www.who.int/csr/don/2014_04_25_ebola/en/

3. European Centre for Disease Prevention and Control. Epidemiological Update: Outbreak of Ebola Virus Disease in West Africa. 25 April 2014. [Accessed 1 May 2014]. Available at: http://www.ecdc.europa.eu/en/press/news/_layouts/forms/News

_DispForm.aspx?List=8db7286c-fe2d-476c-9133-18ff4cb1b568&ID=991

4. Beeching NJ, Fletcher TE, Hill DR, Thomson GL. Travellers and viral haemorrhagic fevers: what are the risks? Int J Anti Micro Agents 36:S26-S35, 2010.

5. European Centre for Disease Prevention and Control. Rapid Risk Assessment - Outbreak of Ebola haemorrhagic fever in West Africa. 8 April 2014. [Accessed 1 May 2014]. Available at:

http://www.ecdc.europa.eu/en/publications/Publications/Ebola-RRA-West-Africa-8April2014.pdf

6. Public Health England. Ebola. [Accessed 1 May 2014]. Available at: http://www.hpa.org.uk/topics/infectiousdiseases/infectionsaz/ebo

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Links

Public Health England: Ebola

European Centre for Disease Prevention and Control: Ebola Travel Advice

World Health Organization: Ebola haemorrhagic fever

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